title: Initial treatment of hypertension: a questionnaire survey.
abstract: The "stepped care" (SC) approach to the management of hypertension has been the standard of care for many years. Recently, concerns about safety of diuretics, coupled with the development of a variety of new antihypertensive agents, have led to questions about the continued use of SC. It is unclear what effect this continuing debate has had on the initial selection of drugs to treat mild to moderate hypertension. We developed four vignettes intended to represent typical patients with mild to moderate hypertension and asked three groups of physicians (house staff, faculty physicians, and private practitioners) how they would initially treat the patients represented by the vignettes. Ninety-five physicians responded. Among the physicians who chose a drug therapy for a vignette (85.9% of total responses), 81.2% selected either a diuretic or a beta-blocking agent, the standard SC regimen. Differences among the groups of physicians dealt with decisions to treat rather than choice of drugs, although house officers tended to use slightly more beta blockers and non-SC drugs. In spite of recent criticism of the SC approach, many physicians are comfortable with the use of diuretics or beta-blocking agents as the initial treatment of mild to moderate hypertension.
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D003657:Decision Making; D004363:Drug Utilization; D005431:Florida; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents