|
|
Vol. 55, No. 7, July 2009, pp.728 - 734 Copyright © 2009 by The College of Family Physicians of Canada
Drug management for hypertension in type 2 diabetes in family practiceWayne Putnam, MDFamily physician, researcher, and Associate Professor in the Department of Family Medicine at Dalhousie University in Halifax, NS.
Farokh Buhariwalla, MD
Kendrick Lacey, MD
Mary Goodfellow, MD
Rose Anne Goodine, MD
Jennifer Hall, MD
Ian MacDonald, MD
Michael Murray, MD
Preston Smith, MD
Fred Burge, MD MSc
Nandini Natarajan, MD
Beverley Lawson, MSc
Correspondence: Dr Wayne Putnam, Queen Elizabeth II Health Sciences Centre, Department of Family Medicine, Dalhousie University, 5909 Jubilee Rd, Halifax, NS B3H 2E2; telephone 902 496-4740; e-mail wayne.putnam{at}dal.ca 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. DESIGN Practice-based, cross-sectional observational study. SETTING Seventeen rural and urban family practices in the Maritime Family Practice Research Network in Nova Scotia, New Brunswick, and Prince Edward Island. PARTICIPANTS A total of 670 patients with type 2 diabetes, ranging from 25 to 92 years of age. MAIN OUTCOME MEASURES 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 β-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, β-blockers, or calcium channel blockers. The most commonly used medications were prescribed at higher than two-thirds the maximum dose effective for hypertension. CONCLUSION 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. This article has been cited by other articles:
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
