Managing hypertension in family practice: a nationwide collaborative study of the use of four antihypertensives in the treatment of mild-to-moderate hypertension. A report from CEN. Clinical Experience Network.

The goals of this prospective, nonexperimental study were to examine the ways in which family physicians select from among four antihypertensive agents for their patients and to provide an overall perspective on how these agents perform in the management of hypertension in primary care. Three hundred seventy-eight family physicians treated 3608 mild and moderate hypertensives with one of the following medications: atenolol (n = 564 patients), enalapril maleate (n = 677), verapamil hydrochloride in sustained-release form (n = 1861), or a fixed combination, hydrochlorothiazide/triamterene (n = 506). The resultant four groups of patients differed in several demographic and clinical measures: age, gender, race, concurrent disease, diastolic and systolic blood pressures, heart rate, and history of hypertension. The patient profiles for each group suggest appropriate matching of drugs to individual patient needs: younger patients and those with higher heart rates more often received the beta-blocker; blacks were more frequently assigned to the diuretic and less often to the beta-blocker; patients with concurrent diseases and a longer history of hypertension were more often assigned to the angiotensin-converting-enzyme (ACE) inhibitor or the calcium channel blocker. Rates of success, defined by the percentages of patients staying on the selected drug and experiencing a reduction of at least 10 mmHg or achieving a diastolic pressure less than or equal to 90 mmHg, were in the same range for all four groups (55 to 62.5 percent). Patients evaluated their quality of life and gave enalapril and verapamil SR the highest ratings. The rapid completion of the study, the quality of the results, and the high rates of follow-up and compliance show that family practice is an excellent setting for conducting clinical research.