title: Prescribing pattern of antihypertensive drugs by family physicians and general practitioners in the primary care setting in Bahrain.
abstract: The aim was to determine whether there are differences among family physicians (FPs) and general practitioners (GPs) in terms of their preference for different classes of antihypertensives, either alone or in combinations, in uncomplicated cases of hypertension and to determine the extent of adherence to WHO/ISH guidelines. We have analysed prescribing of antihypertensives by qualified family physicians (FPs) (n=77) and compared this with that of general practitioners (GPs) (n =41) by auditing 1791 prescriptions of FPs and 914 prescriptions of GPs, issued to patients with uncomplicated hypertension, at 15 out of 20 health centres in Bahrain. The choice of antihypertensive(s) by FPs and GPs was comparable and conformed with the WHO/ISH guidelines as regards preference for: (i) beta-blockers, angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers (CCBs) as monotherapy; (ii) two-drug combinations (diuretic-beta-blocker; beta-blocker-CCB); (iii) three-drug combinations (diuretic-beta-blocker-CCB; diuretic-beta-blocker-ACE inhibitor; beta-blocker- ACE inhibitor-CCBs), and (iv) choice of drug used for the elderly either alone (CCBs) or as combinations (diuretic-beta-blocker; beta-blocker-CCB and diuretic-beta-blocker-ACE inhibitor; diuretic-beta-blocker-CCB). In several instances prescribing by both FPs and GPs was not in accordance with the WHO/ISH guidelines: reluctance to prescribe diuretics as monotherapy; use of suboptimal combinations (beta-blocker-ACE inhibitor); and extensive use of beta-blockers and irrational use of immediate-release nifedipine in elderly. A statistically significant prescribing difference between FPs and GPs was evident in the following: beta-blockers as monotherapy (P =0.01), diuretic-CCB (P=0.046), and diuretic-CCB-methyldopa (P=0.01) combination, and immediate-release nifedipine monotherapy in the elderly (P=0.027), were prescribed more often by the GPs. However, beta-blocker-ACE inhibitor-CCB combination was more often prescribed by FPs (P=0.046). Remarkable differences in prescribing pattern of antihypertensives between the FPs and GPs were evident. Although the general pattern supported a superior prescribing profile of the FPs as expected, there is a need for improved prescribing by both GPs and FPs. Educational programmes, both graduate and residency training, and continuing professional education, should specifically address these deficiencies in order to assure quality primary health care.
authors.affiliation: Associate Professor, Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain. sequeira@agu.edu.bh
authors.forename: Reginald P
authors.initials: RP
authors.lastname: Sequeira
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Jassim
authors.forename: Awatif H H
authors.initials: AH
authors.lastname: Damanhori
authors.forename: Vijay S
authors.initials: VS
authors.lastname: Mathur
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001445:Bahrain; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004363:Drug Utilization; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010821:Physicians, Family / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics