title: Evaluation of prescribing patterns in a German network of CAM physicians for the treatment of patients with hypertension: a prospective observational study.
abstract: BACKGROUND
  The management of hypertension is a key challenge in modern health systems. This study aimed to investigate hypertension treatment strategies among physicians specialized in complementary and alternative medicine (CAM) in Germany by analysing prescribing patterns and comparing these to the current treatment guidelines issued by the German Hypertension Society.
  
  
  METHODS
  In this prospective, multicentre observational study, which included 25 primary care physicians specialized in CAM treatment, prescriptions and diagnoses were analysed for each consecutive hypertensive patient using routine electronic data. Data analysis was performed using univariate statistical tests (Chi square test, Cochran-Armitage trend test). Multiple logistic regression was used to determine factors associated with antihypertensive medication.
  
  
  RESULTS
  In the year 2005, 1320 patients with 3278 prescriptions were included (mean age = 64.2 years (SD = 14.5), 63.5% women). Most patients were treated with conventional antihypertensive monotherapies (n = 838, 63.5%). Beta-blockers were the most commonly prescribed monotherapy (30.7%), followed by ACE inhibitors (24.0%). Combination treatment usually consisted of two antihypertensive drugs administered either as separate agents or as a coformulation. The most common combination was a diuretic plus an ACE inhibitor (31.2% of dual therapies). Patient gender, age, and comorbidities significantly influenced which treatment was prescribed. 187 patients (14.2%) received one or more CAM remedies, most of which were administered in addition to classic monotherapies (n = 104). Men (OR = 0.66; 95% CI: 0.54-0.80) and patients with diabetes (OR = 0.55; 95% CI: 0.42-0.0.73), hypercholesterolaemia (OR = 0.59; 95% CI: 0.47-0.75), obesity (OR = 0.74; 95% CI: 0.57-0.97), stroke (OR = 0.54; 95% CI: 0.40-0.74), or prior myocardial infarction (OR = 0.37; 95% CI: 0.17-0.81) were less likely to receive CAM treatment.
  
  
  CONCLUSIONS
  The large majority of antihypertensive treatments prescribed by CAM physicians in the present study complied with the current German Hypertension Society treatment guidelines. Deviations from the guidelines were observed in one of every seven patients receiving some form of CAM treatment.
authors.affiliation: Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany. ejeschke@havelhoehe.de
authors.forename: Elke
authors.initials: E
authors.lastname: Jeschke
authors.forename: Thomas
authors.initials: T
authors.lastname: Ostermann
authors.forename: Horst C
authors.initials: HC
authors.lastname: Vollmar
authors.forename: Matthias
authors.initials: M
authors.lastname: Kröz
authors.forename: Angelina
authors.initials: A
authors.lastname: Bockelbrink
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Witt
authors.forename: Stefan N
authors.initials: SN
authors.lastname: Willich
authors.forename: Harald
authors.initials: H
authors.lastname: Matthes
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000529:Complementary Therapies; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019370:Observation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012737:Sex Factors
chemical_list: D000959:Antihypertensive Agents