[Selection of pharmacologic treatment of arterial hypertension in primary care. Task force on Pharmacologic Approach of Hypertension in Primary Care (AFHAP)].
BACKGROUND
To assess whether patients' clinical characteristics, and more specifically contraindications to diuretics or beta-blockers have an influence on the prescription patterns of antihypertensive drugs.


METHODS
Cross-sectional descriptive study of consecutive hypertensive patients attending 28 Primary Health Care Centres in Barcelona between November 1997 and February 1998. Information on patients' clinical characteristics and prescribed antihypertensive and other drugs was recorded. Hyperuricemia, a previous adverse drug reaction and potential drug interactions were considered as contraindications to diuretics. Asthma, chronic obstructive airway disease, peripheral arteriopathy, bradycardia, atrio-ventricular blockade, type 1 diabetes, a previous adverse drug reaction, and potential drug interactions were considered as contraindications to beta-blockers.


RESULTS
Eighty-three general practitioners and 29 nurses collected data on 1,813 patients (66% were women and mean age was 68 years). Dyslipemia was present in 746 patients (41.1%), diabetes in 385 (21.2%), hyperuricemia in 251 (13.8%), coronary heart disease in 218 (12%), and heart failure in 128 (7.1%). Diuretics were contraindicated in 350 patients (19.3%) and beta-blockers in 537 (29.6%). Eight-hundred seventy-nine patients (48.5%) were prescribed an angiotensin-converting-enzyme (ACE) inhibitor, 803 (44.3%) a diuretic, 521 (28.7%) a calcium-channel blocker, and 246 (13.6%) a beta-blocker. The prescription pattern was similar in both patients with existing contraindications to diuretics or beta-blockers, or without them, and in those with and without diabetes, heart failure or coronary heart disease and in those whose clinical characteristics would make the prescription of a diuretic, a beta-blocker or an ACE-inhibitor a first choice option. Prescription of a diuretic was associated to age and to existing contraindications to a beta-blocker, whereas the prescription of a beta-blocker was associated with a history of coronary heart disease.


CONCLUSIONS
The present study suggests that contraindications to diuretics or beta-blockers are not considered when prescribing antihypertensive drugs. The results of clinical trials are not applied to clinical practice, and this results in a high proportion of patients not being offered the benefit of cardiovascular risk prevention.
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D011320:Primary Health Care
D000959:Antihypertensive Agents