Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Ford, Gary A.; Asghar, MN

doi:10.1111/j.1365-2125.1995.tb04481.x

Cited by 18 publications

(10 citation statements)

References 22 publications

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“…We have established that thaizide diuretics is the most frequently prescribed agent either as a monotherapy or combination therapy for the management of hypertension in our study site. This finding was similar to the results of the studies from Britain, Italy, Spain, South Africa and Canada where diuretics have been shown to be the most popular medication for the treatment of hypertension (Ford and Asghar, 1995;Wallenius et al, 1988;Edward et al, 1998). This practice is in line with the JNC 7 report which have placed emphasize on the use of thaizide type diuretics as first line agent for the management of hypertension.…”

Section: Discussionsupporting

confidence: 89%

“…The 2014 evidence-based guidelines for the management of high blood pressure in adults (JNC 8) also favoured the use of thiazide diuretics and CCBs as initial therapies in blacks (James et al, 2014). In countries like Taiwan and the United States, CCB were the most prescribed medication for the management of hypertension (Ford and Asghar, 1995;Chou et al, 2004). Meanwhile, many studies support the use of CCB and diuretics in the elderly and black Africans (ALLHAT Collaborative Research Group, 2002;Adigun et al, 2003) in line with the newly published guidelines.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the prescription pattern of antihypertensive agents in a tertiary health institution in Nigeria

Amara¹,

Nduka²,

Uduma³

et al. 2015

Afr. J. Pharm. Pharmacol.

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Hypertension is a cardiovascular disease with high morbidity and mortality. Effective blood pressure control can be achieved in patients with lifestyle modifications and by the use of antihypertensive agents. The objective of this study was to determine the prescribing pattern of antihypertensive medications in a tertiary health institution in South-Eastern Nigeria and also to determine the prescribers' compliance to recognised treatment guidelines. This was a retrospective cross sectional study and a total of 848 prescriptions generated from 202 hypertensive case files were used. Data extracted from the case files of hypertensive patients who attended the hospital from January to December, 2010 were coded and analysed using Statistical Package for Social Sciences (SPSS). The mean age of the patients consisting of mainly females (n=119, 59%) and then, males (n=83, 41%) was 59 years. Stage 2 hypertension was the most common class seen among the patients followed by stage 1 and then, the prehypertension with antihypertensive agents prescribed at all the stages. Co-morbid conditions increased with increase in blood pressure with type 2 diabetes being the most common, followed by congestive heart failure (CHF). The study also showed that the two most commonly prescribed agents either as monotherapy or as combination therapy were diuretics (D) and calcium channel blockers (CCBs) followed by angiotensin converting enzyme inhibitors (ACEIs) with angiotensin receptor blockers (ARBs) being the least prescribed. This study showed that there were reductions in the mean systolic and diastolic blood pressures with a decrease in mean arterial pressure (MAP) from 118 to 104 mmHg after initiation of therapy. This study shows a good adherence to current evidence based treatment guidelines and hypertension treatment guidelines.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Evaluation of the prescription pattern of antihypertensive agents in a tertiary health institution in Nigeria

Amara¹,

Nduka²,

Uduma³

et al. 2015

Afr. J. Pharm. Pharmacol.

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“…For example, there is still a demand for more easily tolerated medications that may improve patient compliance and the control of hypertension. 29,30 Even if pharmaceutical therapy is optimized to modify risk factors for stroke, the most effective means of reducing stroke risk are those incorporating lifestyle changes. When feasible, this should be the first approach taken with patients.…”

Section: Discussionmentioning

confidence: 99%

Risk Factor Modification in Stroke Prevention

Joseph

Babikian

Allen

et al. 1999

Stroke

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Background and Purpose-We reviewed Stroke Clinic data to determine the extent of risk factor modification achieved in patients with cerebrovascular disease over 2 years. Methods-Visits to the Stroke Clinic of a tertiary medical center from July 1, 1994, through June 30, 1996, were reviewed.Obesity, smoking, hypertension, hyperlipidemia, hyperglycemia, and lifestyle changes were noted in patients with Ն2 visits (nϭ61) and measures (number varied) of these parameters. Results-Fifty-six patients (92%) had primary care physicians. In the 49 patients with Ն2 weight measurements, 33 (67%)were moderately or severely overweight by weight-height correlation. Forty-four patients (90%) remained in the same weight category. Of the 60 patients with available blood pressure data, 50 (83%) were hypertensive. At their last visits, 43 of the 50 (86%) were receiving medications, and 22 of the 43 treated (51%) were controlled. Serum glucose remained elevated in 14 of 47 patients (30%) and in 11 of 16 diabetic patients (69%). Thirty-six of 47 patients (55%) had elevated lipid measurements. None of the 21 smokers quit during the study period. Few patients modified dietary and exercise practices. Of 61 patients, 29 (48%) sustained vascular events during the study, with 17 of these 29 patients (59%) having strokes or transient ischemic attacks. Conclusions-Although most patients were asked to quit smoking, received advice regarding diet and exercise, and were medicated for hypertension, elevated glucose, and cholesterol levels, their risk factor profiles showed little improvement during the 2-year period. More effective methods of controlling stroke risk factors are needed. (Stroke. 1999;30:16-20.)

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“…The 2002/2003 WHO‐ISH and European guidelines suggested that ACEIs, ARBs, BBs, CCBs, and thiazides are all drugs of first choice. It was also noted in Britain, Italy, Spain, South Africa, and Canada that diuretics were a popular treatment for hypertension 56 – 58 . Reports on the influence of practice guidelines on physician behavior indicate that there is suboptimal adherence to guidelines 59 .…”

Section: Discussionmentioning

confidence: 99%

“…It was also noted in Britain, Italy, Spain, South Africa, and Canada that diuretics were a popular treatment for hypertension. [56][57][58] Reports on the influence of practice guidelines on physician behavior indicate that there is suboptimal adherence to guidelines. 59 Other research has shown little effect of clinical trials on prescribing patterns.…”

Section: Figure 2 Prescribing Trends For Patients With and Without Dmentioning

confidence: 99%

Adherence to Available Clinical Practice Guidelines for Initiation of Antihypertensive Medication in Patients With or Without Diabetes Mellitus and Other Comorbidities in Taiwan

Chou¹,

Lin²,

Kao³

et al. 2012

The Journal of Clinical Pharma

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The aim of the study is to explore the prescribing trends for antihypertensive medications in newly diagnosed hypertensive subjects with different comorbidities with or without diabetes in Taiwan. Factors for prescribing angiotensin receptor blockers (ARBs) are also investigated. The study design is a secondary data analysis of Taiwanese population from the National Health Insurance, from 1997, to 2004. A total of 3 218 187 patients were included in the statistical analysis; there were 2 963 861 cases without diabetes and 254 326 with diabetes. From 1998 to 2004, in both arms, there were significant trends for increasing ARB use (ρ = 0.964, P < .001). Patients with preexisting diabetes were more likely to be prescribed ARBs than those without preexisting diabetes (OR = 1.68; 95% CI, 1.65-1.70). A similar situation was noted for patients with the comorbidities of cerebrovascular accident (OR = 1.61), congestive heart failure (OR = 2.20), coronary artery disease (OR = 1.63), and chronic kidney disease (OR = 2.23). Although diuretics were not the most commonly prescribed antihypertensive for nondiabetics during the study period, physicians' prescribing practices were within the range of published clinical practice guidelines for hypertension management. Further comprehensive studies are needed to explore the impact of prescription patterns, especially ARBs, on the allocation of health care resources and therapeutic efficacy in Taiwan.

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Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Cited by 18 publications

References 22 publications

Evaluation of the prescription pattern of antihypertensive agents in a tertiary health institution in Nigeria

Evaluation of the prescription pattern of antihypertensive agents in a tertiary health institution in Nigeria

Risk Factor Modification in Stroke Prevention

Adherence to Available Clinical Practice Guidelines for Initiation of Antihypertensive Medication in Patients With or Without Diabetes Mellitus and Other Comorbidities in Taiwan

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