Beaulieu M D, Dufresne L, LeBlanc D
Family Medicine Clinic, Notre-Dame Hospital.
Can Fam Physician. 1998 Feb;44:294-8, 301-2.
To evaluate whether physicians are prescribing antihypertensive drugs appropriately and according to the recommendations of the Canadian Hypertension Society.
Retrospective cohort study.
Family medicine teaching clinic in Montreal.
A cohort of 183 patients followed between 1993 and 1995. Of 350 patients registered at the clinic, 167 were excluded because diagnosis of hypertension was not supported by chart review, their charts contained insufficient information, they were pregnant or younger than 18 years, or they had secondary hypertension and complex medical conditions.
The dependent variable was the antihypertensive medication. Independent variables were age and sex of patients, duration of hypertension, total number of visits and number of visits for hypertension, number of physicians consulted at the clinic, associated medical conditions, diagnosis of target organ damage, blood pressure readings, and associated medications.
Diuretics were prescribed most frequently (45.9%). Angiotensin-converting enzyme (ACE) inhibitors ranked second (28.4%), followed by calcium channel blockers (26.2%) and beta-blockers (18.0%). Age, sex, duration of hypertension, and blood pressure readings were not associated with medications. Prescription of beta-blockers was strongly associated with previous myocardial infarction, but not with diagnosis of angina pectoris. Patients with contraindications to beta-blockers were less likely to receive them and more likely to receive calcium channel blockers. Only 32% of diabetic patients received ACE inhibitors.
Results suggest that some prescriptions for antihypertensive medications are inappropriate, but that physicians are following some of the Canadian Hypertension Society's recommendations. A better understanding of physicians' prescribing behaviours could help target continuing education interventions to improve prescribing for hypertension.
评估医生是否按照加拿大高血压协会的建议合理开具抗高血压药物。
回顾性队列研究。
蒙特利尔的家庭医学教学诊所。
1993年至1995年间随访的183名患者队列。在诊所登记的350名患者中，167名被排除，原因包括病历审查不支持高血压诊断、病历信息不足、怀孕或年龄小于18岁，或患有继发性高血压和复杂的医疗状况。
因变量为抗高血压药物。自变量为患者的年龄和性别、高血压病程、就诊总次数和高血压就诊次数、在诊所咨询的医生数量、相关医疗状况、靶器官损害诊断、血压读数以及相关药物。
利尿剂的处方最为常见（45.9%）。血管紧张素转换酶（ACE）抑制剂位居第二（28.4%），其次是钙通道阻滞剂（26.2%）和β受体阻滞剂（18.0%）。年龄、性别、高血压病程和血压读数与药物使用无关。β受体阻滞剂的处方与既往心肌梗死密切相关，但与心绞痛诊断无关。有β受体阻滞剂禁忌证的患者接受此类药物的可能性较小，而接受钙通道阻滞剂的可能性较大。只有32%的糖尿病患者接受了ACE抑制剂。
结果表明，一些抗高血压药物的处方并不恰当，但医生遵循了加拿大高血压协会的一些建议。更好地了解医生的处方行为有助于针对继续教育干预措施，以改善高血压的处方开具情况。
