Drug management for hypertension in type 2 diabetes in family practice.
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.
Putnam
Wayne
W
Department of Family Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 2E2. wayne.putnam@dal.ca
Buhariwalla
Farokh
F
Lacey
Kendrick
K
Goodfellow
Mary
M
Goodine
Rose Anne
RA
Hall
Jennifer
J
Macdonald
Ian
I
Murray
Michael
M
Smith
Preston
P
Burge
Fred
F
Natarajan
Nandini
N
Lawson
Beverley
B
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*
D000959:Antihypertensive Agents