title: Evaluation of the agreement between guidelines and initial antihypertensive drug treatment using a national health care reimbursement database.
abstract: OBJECTIVE
  To test the agreement between guidelines for the management of hypertension and medical practices while avoiding frequent limitations such as the use of non-representative samples of practitioners and self-reporting of their practices over a short period of time.
  
  
  METHODS
  The characteristics of initial antihypertensive drug treatment in a large representative sample of the French population aged 50-80 (n = 17 855) were collected from a national health care reimbursement database and compared with national guidelines over a 5-year period.
  
  
  RESULTS
  Major discrepancies are observed including the use of non-recommended drug classes such as loop and potassium sparing diuretics alone or in association and the absence of distinction between patients according to their age. More minor discrepancies are the preferential use of mono-therapies over drug combinations and of some bi-therapies among those recommended. Some degree of concordance with the guidelines is also observed including the specific characteristics of the treatment of diabetics compared with other categories of patients and the preferential use of long-acting dihydropyridine calcium antagonists and of low-dose thiazide diuretics when these drug classes are chosen. Several of these discrepancies or concordances, which mainly reflect general practitioner (GP) activity, show time trends over the entire follow-up period with no significant effect of the guideline released during this period.
  
  
  CONCLUSIONS
  At the French national level, the agreement between initial antihypertensive drug treatment and guidelines varies considerably depending on the characteristics of the treatment that are considered. The GPs who delivered the treatment do not seem to have been influenced by the guidelines released over the last decade.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Paris, France. pierre.meneton@spim.jussieu.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Meneton
authors.forename: Philippe
authors.initials: P
authors.lastname: Ricordeau
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
authors.forename: Philippe
authors.initials: P
authors.lastname: Tuppin
authors.forename: Solène
authors.initials: S
authors.lastname: Samson
authors.forename: Hubert
authors.initials: H
authors.lastname: Allemand
authors.forename: Pierre
authors.initials: P
authors.lastname: Durieux
authors.forename: Joël
authors.initials: J
authors.lastname: Ménard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D019992:Databases as Topic; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'
chemical_list: D000959:Antihypertensive Agents