title: Regional and physician specialty-associated variations in the medical management of atherosclerotic renal-artery stenosis.
abstract: For people enrolled in Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL), we sought to examine whether variation exists in the baseline medical therapy of different geographic regions and if any variations in prescribing patterns were associated with physician specialty. Patients were grouped by location within the United States (US) and outside the US (OUS), which includes Canada, South America, Europe, South Africa, New Zealand, and Australia. When comparing US to OUS, participants in the US took fewer anti-hypertensive medications (1.9 ± 1.5 vs. 2.4 ± 1.4; P < .001) and were less likely to be treated with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (46% vs. 62%; P < .001), calcium channel antagonist (37% vs. 58%; P < .001), and statin (64% vs. 75%; P < .05). In CORAL, the identification of variations in baseline medical therapy suggests that substantial opportunities exist to improve the medical management of patients with atherosclerotic renal-artery stenosis.
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Folt
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
authors.forename: Kaleigh L
authors.initials: KL
authors.lastname: Evans
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
authors.forename: Sravya
authors.initials: S
authors.lastname: Brahmandam
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
authors.forename: Wencan
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Brewster
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
authors.forename: Shipeng
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Murphy
authors.affiliation: Department of Medicine, Harvard Clinical Research Institute, Boston, MA, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
authors.affiliation: Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Lance D
authors.initials: LD
authors.lastname: Dworkin
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jamerson
authors.affiliation: The University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: William
authors.initials: W
authors.lastname: Henrich
authors.affiliation: Department of Medicine, Salford Royal Hospital NHS Foundation Trust, Greater Manchester, United Kingdom.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
authors.affiliation: Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Tobe
authors.affiliation: Department of Radiology, Alfred Hospital, Melbourne, Australia.
authors.forename: Ken
authors.initials: K
authors.lastname: Thomson
authors.affiliation: Department of Radiology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Holden
authors.affiliation: Department of Medicine, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Rayner
authors.affiliation: Department of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Liliana
authors.initials: L
authors.lastname: Grinfeld
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA. Electronic address: Steven.haller@utoledo.edu.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Haller
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000473:pathology* / Q000628:therapy; D002170:Canada; D019468:Disease Management; D005060:Europe; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000175:diagnosis* / Q000188:drug therapy*; D038622:Internationality; D016014:Linear Models; D008297:Male; D008511:Medicine; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000473:pathology / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013019:South Africa; D013020:South America; D014481:United States
chemical_list: D000959:Antihypertensive Agents
keywords: Antihypertensive medical therapy; geography; renovascular hypertension