University of South Carolina School of Medicine-Greenville, Greenville, South Carolina.
Department of Medicine, Southern Illinois University School of Medicine, Springfield, Illinois.
J Clin Hypertens (Greenwich). 2018 Oct;20(10):1464-1472. doi: 10.1111/jch.13375. Epub 2018 Oct 5.
A quantitative survey was completed by 103 primary care physicians (PCPs) and 59 cardiologists who regularly prescribed β-blockers to assess knowledge and use of this heterogeneous drug class for hypertension. More cardiologists than PCPs chose β-blockers as initial antihypertensive therapy (30% vs 17%, P < 0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. Cardiologists rated "impact on energy" and "arterial vasodilation" as more important than PCPs (P < 0.05/<0.01, respectively). Awareness of vasodilation was greater for carvedilol (52%) than nebivolol (31%). Association between β-blockers and clinical variables included nebivolol with β -selectivity, nebivolol and carvedilol with vasodilation and efficacy in older patients and African Americans, metoprolol with heart rate reduction, and atenolol and metoprolol with weight gain and hyperglycemia. Physicians preferred prescribing β-blockers with lower risk of incident diabetes. Clinical practice guidelines influenced physician prescribing more than formularies or performance metrics. This survey captures physicians' perceptions/use of various β-blockers and clinically relevant knowledge gaps.
一项针对 103 名初级保健医生（PCP）和 59 名经常开具β受体阻滞剂治疗高血压的心脏病专家的定量调查，评估了他们对这一异质性药物类别的了解和使用情况。与 PCP 相比，更多的心脏病专家选择β受体阻滞剂作为初始降压治疗（30%比 17%，P < 0.01）。美托洛尔和卡维地洛是最常被开的β受体阻滞剂。与 PCP 相比，心脏病专家认为“对能量的影响”和“动脉扩张”更重要（P < 0.05/0.01）。对卡维地洛的血管扩张作用的认识（52%）高于比索洛尔（31%）。β受体阻滞剂与临床变量之间的关联包括：比索洛尔具有β选择性，比索洛尔和卡维地洛具有血管扩张作用和在老年患者和非裔美国人中的疗效，美托洛尔具有降低心率的作用，阿替洛尔和美托洛尔具有增加体重和高血糖的作用。医生更倾向于开发生物利用度较低的β受体阻滞剂，以降低新发糖尿病的风险。临床实践指南对医生的处方影响大于处方集或绩效指标。这项调查反映了医生对各种β受体阻滞剂的看法和使用情况，以及临床相关的知识差距。
