Antihypertensive drug prescribing by physicians

AfH-APRIL 1995-VOL.8, NO.4, PART 2

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VARIABILITY INLIPID MEASUREMENTS. PB Bot~ M Carr.,WH Kaesemeyer*. Medical College ofGeorgia and Augusta Hypertension, Augusta, GA. One of the National Cholesterol Education Program(NCEP) guidelines is for Americans tolower serum total cholesterol to <200mgfdL tolower risks of cardiovascular events. Precision (test repeatability ofsame sample) and biological varlabllity(le.st-retest repeatability) between visits among ~nticnts must beconsidered. We documented the variability umong 73patients separated by 2 wks after lipidemia notcontrolled by ~6 wits NCEP stage 1 diet. Tolal and HOL cholesterol(TC, HOL) and triglycerides(TG) in mgldL were measured by a laboratory standardized toa sel point for CDC-Lipid Standardization Program in mgldL, Precision at 95% confidence: TC-1.6%; 1'0-2.5%; HOL-9.3%. LDL was calculated from TC, HOL and TO. VlUiability is the standard deviation of differences(SDD) between 2 visits and 1.96 x 50D=95% confidence(C). TC HOL TG LOL mean 273v266 5Ov49 185v194 181v175 SOD 23 5 72 20 95% C 45 10 141 39 Apatient's variability between visits may be 167 to233 mgldL for TCof200 mgldL, 125 to 192 mgfdL forLOL of 160 mgldL and 28 to42mgldL for HOL of2S mgldL. The average oflipid measurements on2 ormore visits is needed to determine alevel among individuals in order toclassify according theNCEP.

Key Words:

POSTERS: Patient Evaluation and Management 91A

lipids, cardiovascular risk

ANTIHYPERTENSIVE DRUG PRESCRIBING BY PHYSICIANS. M ClUT* and LM Prisanl·, Medical College ofGeorgia, Augusta, Ga. Communications with 231 physicians were completed byApril 1993. Demographics: 3O.3%-family medicine (PM); 33.8%-intemal medIcine (IM); 19.9%nephrology (N)j 16%- Endocrine (B). Patients evaiuatedlweek,% hypertensives were: 142,'28.7%-FM; 86, 3S.6%-IM; 47, 58.7%-N;7S, 30.3% -(E). Uncomplkated hypertensives were; 43%-FM, 37%-IM, 18%-N, and 33%-E. A higher % of hypertenslves treated byN hQd; renal faill1re(RF}-SO%, diabetespM)·32%, congestive hear.t (alll1.~ (CHF)-19%,atherosclerosis (ATHS)-4I% and treated by E,48 % -OM. Physicians were questioned re: preferences ofvarious classes of antihyPertensives; calcium antagonists(CA), angiotensin converting enzyme inhibitors (ACEI), beta blockers(BB), JJiuretics(D), which were: uncomplicated hypertension44%-CA, 36%-ACEI, 3%·BB, 8%-0; hypertensiveangina-73%-CA,2%-ACEI, 9%-BB,
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Antihypertensive Drug Therapy: The Effect of INC IV and V on Prescription Patterns and Associated Outcomes at One Year.

ANJauIY

M,H,Alderman', S.Madhavan, H,Cohen, Albert Einstein College of Medicine, Bronx, N.Y. Toevaluate the impact of Joint National Conunittee on the Detection, Evaluation, and Treatment of Hypertension (INC) recommendations for initial drug usein antihypertensive therapy, first drug prescription and oneyear outcomes (changes in blood pressure OJP) and therapy, and drop-out rate) were examined in 53J new patients who began treatment on monotherapy in a program guided by INC recommendations during three representative periods [I (23J): pre-INC IV (1986-87), II (19/1): post-JNeIV (1990-91) and III (106): po~t-]NC V (1992)]. In I, 87% began with diuretics (0) [146] or beta blockers (BB) (85], in 11, 90% started with calcium channel blockers (CAB) (lOS] or angiotensin converting enzyme inhibitors (ACE) (89J, and in III, 22% [24J D, 29% f3';J BD, 26% f28J CAB and 20% [22] ACE. Due to demographic variations and differences in initial BPbetween periods, patients in If[ were sex·race·age matched with those in I atId II, and all three groups (I-III) had similar initial BP (150/100, 153/97, 152/981YtUl Hg). Althouglfi thethree groups differed demographically, these differences did notinfluence outcomes. Despite differences in 1stdrug, tina! BPs (I: 137/92, II: 141/88, III: 140190 mm Hg), were similar. Thepercent drop-outs (16.9%, 10,2, 9.4), and percent needinz second drug (15.6%, 7.2, 12.3) were similar for II & IJI, and significantly higher for I. In sum, although substantial changes in first antihypertensive prescriptions occurred in theshort term, BP levels, persistence in therapy and number of drugs prescribed were similar before and after ]NCV. Key Words;

Antihypertell' .. =drug, INC IV, JNC V, blood pressure

prescriptions, demographics; hypertension

JmltiIC DIFF'ERE2lCES IN CX>ROHARY ARl'ERY INFIDtl lB Ifm. AI Michel, JL Phillip, Nt

Hel1ches, JL Houghton.. Albany Medical College, Albany, NY. Though significant narrowing of the left main artery (IM) is present in approximately 10% of white Americans (WIl) undergoing coronary angiography for chest pain, it is unc011DIIon in similar black Americans (BA). A possible explanation involves differing 1M inflow conditions. In order to evaluate this, dimensions of the 1M obtained at cardiac catheterization were compared for 25 WA und 25 BA with HTN but without significant coronary disease matched for age, gender, and indexed LV mass. Mean, mid, and distal diameters and length of the 1M were greater in BA compared to WA as shown below (in mm). Length Mean Diam Distal Diam BA 5.2 5.0 17 WA 4.5 4.3 12 0.06 P value 0.04 0.046 Right coronary dominance was present equally among the races, conclusions: !.eft main artery diameter and length are greater in black compared to white hypertensive Americans matched for clinical variables. These findings may help to explain lesser significant coronary disease of the left main artery in BA because of more favorable local hemodynamics •

Key Words: Ethnic differences, left main artery, hypertension