Knapp D A, Michocki R J, Richardson J P, Knapp D A
Center on Drugs and Public Policy, and Schools of Pharmacy and Medicine, University of Maryland, Baltimore.
Pharmacoeconomics. 1994 May;5(5):408-18. doi: 10.2165/00019053-199405050-00007.
We evaluated the management of patients with hypertension (including drug prescribing) by US physicians, compared their prescribing to National Institutes of Health (NIH) guidelines, and compared the pharmacoeconomics of the prescribed antihypertensive drugs. A 1991 national US database, using physician-patient encounter forms, was our data source. Results showed that physicians generally met the NIH guidelines regarding diagnostic/screening services, patient counselling/education, antihypertensive drug prescribing and follow-up. Two areas should be the foci of continuing medical education for US physicians. Firstly, physicians need to be reminded that centrally acting alpha 2-agonists are optimally used as supplemental antihypertensive drugs rather than as initial agents, which is how some physicians utilised them. Secondly, if once-daily administration is used to promote patient compliance, physicians should be aware that, of the frequently prescribed first-line antihypertensive drugs, hydrochlorothiazide, chlorthalidone and atenolol presently have substantially less expensive once-daily dosage forms than other diuretics or beta-blockers, calcium antagonists or ACE inhibitors.
我们评估了美国医生对高血压患者的治疗管理（包括药物处方），将他们的处方与美国国立卫生研究院（NIH）的指南进行比较，并比较了所开降压药的药物经济学。我们的数据来源是1991年美国全国性数据库，使用的是医患诊疗表格。结果显示，医生在诊断/筛查服务、患者咨询/教育、降压药处方和随访方面总体上符合NIH指南。有两个领域应成为美国医生继续医学教育的重点。首先，需要提醒医生，中枢性α2-激动剂最佳用作辅助降压药，而非初始用药，但有些医生就是将其作为初始用药。其次，如果采用每日一次给药以提高患者依从性，医生应意识到，在常用的一线降压药中，氢氯噻嗪、氯噻酮和阿替洛尔目前每日一次剂型的价格比其他利尿剂或β受体阻滞剂、钙拮抗剂或血管紧张素转换酶抑制剂便宜得多。
