Volume 10, Number 3, May-June 2003

Real-life treatment of hypertension in UK primary care: prescribing habits, results and adherence to clinical guidelines
Andrew K Duggan, Christie J Niziol

Recent UK hypertension guidelines from the British Hypertension Society have placed increased importance on antihypertensives that work on the renin-angiotensin system (RAS). There is also an explicit acknowledgement that for many patients monotherapy will be insufficient to achieve hypertensive control. This study aimed to examine antihypertensive prescribing in the UK through an analysis of 6,861 primary care patient records and to compare prescribing patterns with hypertension guidelines. The effects on blood pressure were also examined.
Only 14% of patients achieved normotension after 12 months of treatment; and after 12 months the severity of hypertension did not improve in 39% of diabetic patients. The majority (65%) of severely hypertensive patients were treated with only one agent. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were under-utilised in diabetics both as first-line and add-on therapy, and therapy choices for additions/switches correlated with guidelines in fewer than 40% of cases.
This study shows that there is room for improvement in UK hypertension management, in particular with regard to consideration of co-morbidity in first-line treatment, use of combination rather than monotherapy, and more appropriate additions/switches from first-line therapy as advocated by clinical guidelines.

Br J Cardiol 2003;10:S3-S7.

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