RT Journal Article
SR Electronic
T1 Drug management for hypertension in type 2 diabetes in family practice
JF Canadian Family Physician
JO Can Fam Physician
FD The College of Family Physicians of Canada
SP 728
OP 734
VO 55
IS 7
A1 Putnam, Wayne
A1 Buhariwalla, Farokh
A1 Lacey, Kendrick
A1 Goodfellow, Mary
A1 Goodine, Rose Anne
A1 Hall, Jennifer
A1 MacDonald, Ian
A1 Murray, Michael
A1 Smith, Preston
A1 Burge, Fred
A1 Natarajan, Nandini
A1 Lawson, Beverley
YR 2009
UL http://www.cfp.ca/content/55/7/728.abstract
AB 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.