JNC VI Had Modest Impact on Antihypertensive Prescribing Patterns in the US between 1993 and 2002
- Presenter:
Chair: Katherine McDonald; Discussant: Jun Ma Wed June 7, 2006 8:00-9:30 Room 326
Objective: Practice guidelines aim to guide physician practice according to the best available evidence. Data are mixed regarding the impact of practice guidelines on physician prescribing. We examined patterns of antihypertensive prescribing between 1993 and 2002 to assess the impact of JNC VI released in 1997.
Methods: The 1993-2002 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) provided national estimates of clinician-reported antihypertensive prescribing during patient visits to private physician offices and hospital outpatient departments (OPDs). The main outcome measure was the use of antihypertensive drug classes as proportion of visits for adult patients having hypertension as primary diagnosis who were taking any antihypertensive medications (antihypertensive drug visits).
Results: The number of patient visits involving hypertension as the primary diagnosis ranged from 37,777 to 50,173 per annum, of which 62% to 78% received antihypertensive medications. ACE inhibitors (ACEIs) and calcium channel blockers (CCBs) were leading medication choices by physicians in private practice and OPDs for treating hypertension between 1993 and 1997. After the release of JNC VI, the increase in ACEIs seemed to slow down somewhat and the already present decline in CCBs continued. Also, their role as leading antihypertensive drug class was approached or replaced by thiazide diuretics. In 2002, thiazide diuretics accounted for 34% of antihypertensive drug visits in private physician offices and 40% in OPDs, as opposed to 24% in 1993. The use of other diuretics declined by nearly half from 27% of office-based antihypertensive drug visits to in 1993 to 14% in 2002; the degree of decline was smaller in OPDs from 20% to 16%. -blockers increased from a bit over one-fifth of office-based antihypertensive drug visits between 1993 and 1996 to 30% in 1997 but remained plateau thereafter. For visits in OPDs, however, -blockers increased from 19% in 1933 to 24% in 1997 and then to 35% in 2002.
Conclusions: Our results suggest that practice guidelines can impact prescribing patterns, but the degree of impact seems modest. A range of other clinical and market factors may mitigate the impact of practice guidelines.
