[Influence of cardiovascular risk factors on prescribing of antihypertensives].
OBJECTIVE
The World Health Organization Guidelines on the management of Hypertension recommends to take care of cardiovascular risk factors for selecting drug treatment. The aim of the study was to analyze relationship between cardiovascular risk factors and use of antihypertensive drugs in general practice in France.


METHODS
This was a national cross sectional epidemiological survey performed by 3,152 general practitioners between September 1999 and May 2000. Each investigator had to include 5 consecutive hypertensives (HT) (BP > or = 140/90 or presence of antihypertensive treatment). Cardiovascular risk factors, antihypertensive treatments and office BP were recorded. A stepwise logistic regression analysis was performed for each class of antihypertensive treatment in order to determine risk factors associated with prescription. Significant threshold was fixed at 0.05. Results are expressed in the form of odds ratios (OR).


RESULTS
14,551 treated hypertensives (mean age 60 +/- 10 years, male 56%) were analyzed. Sixteen per cent of patients were diabetics, 17% current smokers and the mean value of cholesterol was 2.29 +/- 0.37 g/L. ACE inhibitors, diuretics, beta-blockers (BB), dihydropyridines, angiotensin II antagonists (AAII), non DHP calcium antagonists (CA) were prescribed in respectively 47%, 35%, 28%, 18%, 14% and 12% of patients. The main risk factors associated with each kind of prescription was diabetes for ACE (OR = 1.36), coronary artery disease for BB, DHP and non-DHP CA (OR = 2.53; 1.51; 1.4 respectively) and BMI for AAII (OR = 1.03). OR > 1 indicates that risk factors was positively linked to prescription. Age had minor influence on selecting drug treatment. Conversely to BB and AAII, the use of ACE and non-DHP CA increases with presence of diabetes and cholesterol increase.


CONCLUSIONS
In general practice, presence of cardiovascular risk factors influences mildly management of hypertension. Conversely to BB, ACE are more prescribed in HT with metabolic disorders.
Vaur
L
L
Laboratoire Aventis, 46, quai de la Rapée, 75601 Paris.
Amar
J
J
Perret
M
M
Bailleau
C
C
Etienne
S
S
Chamontin
B
B
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003657:Decision Making; D048909:Diabetes Complications; D005194:Family Practice; D005260:Female; D005602:France; D014943:Global Health; D019983:Guideline Adherence; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
D000959:Antihypertensive Agents