Trends in Antihypertensive Drug Therapy of Ambulatory Patients by US Office-Based Physicians

Abstract

Abstract-This study assessed trends from 1980 to 1995 in ambulatory patients' antihypertensive drug therapy by US office-based physicians for visits in which hypertension was the principal diagnosis and compared these trends with the respective guidelines given in 5 Joint National Committee (JNC) Reports on Detection, Evaluation, and Treatment of High Blood Pressure published around the same time period. Data from the National Center for Health Statistics' National Ambulatory Medical Care Surveys for 1980, 1990 were used. From 1980 1 In 1995, it accounted for 3.2% of these visits. The purpose of this study was to (1) assess NAMCS trends from 1980 to 1995 in ambulatory patients' antihypertensive drug therapy by US office-based physicians at visits in which hypertension was the principal diagnosis and (2) compare these trends with the respective guidelines given in the 5 Joint National Committee (JNC) reports 2-6 published around the same time period. These were 1975 to 1976 1980, JNC II; 1984, JNC III; 1988, JNC IV;, JNC V. The most recent, JNC VI, was published in 1997. 7 There have been other national surveys that have evaluated antihypertensive drug prescribing trends. 8 -10 However, NAMCS data have the advantages of methodological and analytical consistencies, coverage of the time periods necessary to measure the effects of the first 5 JNC reports, and the ability to assess antihypertensive drug pattern characteristics during patient visits. MethodsNAMCS is a national, probability-sample survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. It collects data on medical care services provided by office-based physicians during ambulatory patient visits. To assess a 15-year trend in antihypertensive drug therapy, 1980, 1985, 1990, and 1995 NAMCS data were used. NAMCS medication data were first collected in 1980. Detailed information on NAMCS sampling and data collection is given in other NAMCS references. [11][12][13][14] Only patient visits having a principal (first-listed) diagnosis of essential hypertension (ICD-9-CM code 401 15 ) were included for this study. The JNC reports 2-6 were used to identify and classify the antihypertensive drugs. To analyze antihypertensive drug prescribing, the following coding procedures were performed. Each hypertension visit in which at least 1 antihypertensive drug was mentioned was counted as an antihypertensive drug visit. On the NAMCS data collection forms, physicians could record the antihypertensive drugs prescribed during the visit by using either generic drug names or brand names. Where brand names were listed, each generic name (active ingredient) component of the drug product was coded separately. Then, each occurrence of an antihypertensive generic name was categorized to its major antihypertensive drug class. If a particular antihypertensive drug class occurred more than once for a visit, it was counted only once. For the first analysis, antihypertensive drug class occurrences, the frequency of occurrence for e...

Measuring Adherence to Practice Guidelines for the Management of Hypertension

“…Nelson and Knapp, 36 focusing on the most frequently prescribed antihypertensive drug classes, concluded that prescribing patterns were generally consistent with guideline recommendations. However, the trends that they described can be interpreted as not being consistent with guideline recommendations.…”

Trends in antihypertensive drugs in the elderly: the decline of thiazides

“…These findings are in agreement with several recent reports describing the progressive decline of diuretic use and the parallel increase in use of ACEinhibitors and CCB that have occurred in other settings. 26,27 The choice of antihypertensive agent does go beyond individual physician's preference because only diuretics and beta-blockers can reduce the incidence of heart failure, as well as stroke, coronary disease, and overall cardiovascular mortality. [6][7][8][9][10] The Systolic Hypertension in Europe trial, 28 the only one to show that a CCB can reduce stroke rate and the incidence of all cardiac events relative to placebo, was published in late 1997 and could not have influenced the prescription pattern in our study.…”

Changes in Antihypertensive Prescribing During US Outpatient Visits for Uncomplicated Hypertension Between 1993 and 2004

“…These surveys, particularly NAMCS, have been validated against other data sources 30 and have also been used in past research of antihypertensive prescribing. 19 In brief, NAMCS captures healthcare services provided by officebased physicians, whereas NHAMCS assesses services offered at hospital outpatient departments. Both surveys use multistage probability sampling procedures, enabling the generation of nationally representative estimates.…”

“…13,18 Past studies tracking practice patterns show that calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACEIs) have increasingly supplanted diuretics and ␤-blockers since their market entry in the early 1980s. 19 The uptake of angiotensin II receptor blockers (ARBs) also has been rapid since their debut in 1995. 20 The growing use of these agents predated clinical evidence supporting their disease-preventing benefits in hypertensive patients.…”