title: Initial medication selection for treatment of hypertension in an open-panel HMO.
abstract: BACKGROUND
  During the past 25 years recommendations for treating hypertension have evolved from a stepped-care approach to monotherapy or sequential monotherapy as experience has been gained and new antihypertensive agents have been introduced. In an effort to develop a disease management strategy for hypertension, we investigated the prescribing patterns of initial medication therapy for newly treated hypertensive patients.
  
  
  METHODS
  We examined paid claims data of an open-panel HMO located in the midwest. Charts from 377 patients with newly treated hypertension from a group of 12,242 hypertensive patients in a health insurance population of 85,066 persons were studied. The type of medication regimen received by patients newly treated for hypertension during an 18-month period was categorized into monotherapy, sequential monotherapy, stepped care, and initial treatment with multiple agents. With monotherapy, the class of medication was also reported. Associations between use of angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, or beta-blockers and presence of comorbid conditions were reported.
  
  
  RESULTS
  Fifty-five percent of patients received monotherapy, 22 percent received stepped care, and 18 percent received sequential monotherapy. Of those 208 patients receiving monotherapy, 30 percent were prescribed a calcium channel blocker, 22 percent an ACE inhibitor, and 14 percent a beta-blocker. No customization of treatment for comorbid conditions was noted.
  
  
  CONCLUSIONS
  Physicians attempt to treat patients' hypertension with monotherapy. In the majority of cases, they have used either a calcium channel blocker or ACE inhibitor as initial monotherapy. Costs for treating hypertension could be reduced and care improved if thiazide diuretics, a combination of potassium-sparing and thiazide diuretics, or beta-blockers were used more frequently as initial monotherapy.
authors.affiliation: John Deere Health Care, Moline, Illinois 61265, USA.
authors.forename: M
authors.initials: M
authors.lastname: Jerome
authors.forename: G C
authors.initials: GC
authors.lastname: Xakellis
authors.forename: G
authors.initials: G
authors.lastname: Angstman
authors.forename: W
authors.initials: W
authors.lastname: Patchin
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D016527:Drug Costs; D006279:Health Maintenance Organizations; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007345:Insurance Claim Review; D015146:Midwestern United States; D010818:Practice Patterns, Physicians'
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics