[The treatment of arterial hypertension. An inquiry among doctors in general practice].
OBJECTIVE
There are many drugs used in the treatment of hypertension. National and international expert committees regularly publish recommendations for antihypertensive treatment. It is not known how doctors in general practive treat hypertension.


METHODS
Questionnaires were sent to 1540 internists, general practitioners and practical doctors in Hamburg, to provide information on their management of hypertensives. There were 458 replies (30%).


RESULTS
38% of replying doctors thought that treatment was required if the blood pressure was above 140/90 mmHg, 53% set the level at 160/95 mmHg and 10% above 180/100 mmHg. Internists among them treated hypertension more vigorously than the general practitioners. The most important qualities of a good antihypertensive drug were effective blood pressure reduction (95%), few side effects (83%) and evidence-based reduction of morbidity and mortality (44%). The most frequently used antihypertensives were ACE inhibitors (98%), followed by beta-blockers (86%), diuretics (60%), calcium antagonists (54%) and AT-1 blockers (22%). The most frequently prescribed calcium antagonist was amlodipine (38%), followed by nifedipine preparations (29%), verapamil (18%) and nitrendipine (6%). Diuretics were named as the best tolerated group of antihypertensive drugs, followed by ACE inhibitors, beta-blockers and AT-1-blockers. ACE inhibitors were preferentially used for patients with diabetes mellitus (84%), heart failure (90%) and renal disease (68). Beta-blockers were prescribe for only 72% of patients with coronary heart disease. 212 of doctors did not prescribed new antihypertensives immediately they became available, while 72 used them at once.


CONCLUSIONS
This survey indicates that internists and general practitioners treat hypertensives according to official recommendations and guidelines. But there is a need for further education regarding the definition of normotensive values, and improvement is still possible in the treatment of associated diseases such as diabetes, coronary heart disease and renal disease.
Wenzel
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Abteilung für Nephrologie/Osteologie, Klinik und Poliklinik für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg. wenzel@uke.uni-hamburg.de
Röben
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Schwietzer
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Stahl
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D000328:Adult; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D011307:Drug Prescriptions; D004363:Drug Utilization; D005194:Family Practice / Q000592:standards*; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007388:Internal Medicine / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012016:Reference Values; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000959:Antihypertensive Agents