title: Drug management for hypertension in type 2 diabetes in family practice.
abstract: OBJECTIVE
  To describe the number and classes of antihypertensive medications prescribed to patients with type 2 diabetes in community family practices, and to estimate the aggressiveness or "dosage intensity" of prescribing for hypertension in these situations.
  
  
  METHODS
  Practice-based, cross-sectional observational study.
  
  
  METHODS
  Seventeen rural and urban family practices in the Maritime Family Practice Research Network in Nova Scotia, New Brunswick, and Prince Edward Island.
  
  
  METHODS
  A total of 670 patients with type 2 diabetes, ranging from 25 to 92 years of age.
  
  
  METHODS
  Number, classes, and combinations of classes of antihypertensive medications prescribed, as well as an index of each medication's dosage intensity.
  
  
  RESULTS
  Almost 80% of patients studied had hypertension. Participants with hypertension were taking an average of 2.5 medications, and 47.6% were taking 3 or more antihypertensive medications, but only 27.1% reached target blood pressure values of less than 130/80 mm Hg. Older patients took more antihypertensive medications, but there were no differences by sex. More than 90% were taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 66% were taking diuretics, 41% were taking beta-blockers, and 38% were taking calcium channel blockers. We cannot describe the sequence in which antihypertensive medication classes were added, but analysis of patients taking multiple drug classes suggests that most patients were started on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, followed by diuretics, beta-blockers, or calcium channel blockers. The most commonly used medications were prescribed at higher than two-thirds the maximum dose effective for hypertension.
  
  
  CONCLUSIONS
  Hypertension is very common among family practice patients with type 2 diabetes; of those patients, few reach target blood pressures. Practice-based strategies to increase dosing and number of medications prescribed might be required.
authors: Department of Family Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 2E2. wayne.putnam@dal.ca
authors: Wayne
authors: W
authors: Putnam
authors: Farokh
authors: F
authors: Buhariwalla
authors: Kendrick
authors: K
authors: Lacey
authors: Mary
authors: M
authors: Goodfellow
authors: Rose Anne
authors: RA
authors: Goodine
authors: Jennifer
authors: J
authors: Hall
authors: Ian
authors: I
authors: Macdonald
authors: Michael
authors: M
authors: Murray
authors: Preston
authors: P
authors: Smith
authors: Fred
authors: F
authors: Burge
authors: Nandini
authors: N
authors: Natarajan
authors: Beverley
authors: B
authors: Lawson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002170:Canada; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004305:Dose-Response Relationship, Drug; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D000959:Antihypertensive Agents