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Research ArticleOriginal Article

Initial Medication Selection For Treatment Of Hypertension In An Open-Panel HMO

Micky Jerome, George C. Xakellis, Greg Angstman and Wayne Patchin
The Journal of the American Board of Family Practice January 1995, 8 (1) 1-6; DOI: https://doi.org/10.3122/jabfm.8.1.1
Micky Jerome
PharmD, MBA
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George C. Xakellis
MD
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Greg Angstman
MD
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Wayne Patchin
MBA
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Abstract

Background: During the past 25 years recommendations for treating hypertension have evolved from a stepped-care approach to monotherapy or sequential monotherapy as experience has been gained and new antihypertensive agents have been introduced. In an effort to develop a disease management strategy for hypertension, we investigated the prescribing patterns of initial medication therapy for newly treated hypertensive patients.

Methods: We examined paid claims data of an open-panel HMO located in the midwest. Charts from 377 patients with newly treated hypertension from a group of 12,242 hypertensive patients in a health insurance population of 85,066 persons were studied. The type of medication regimen received by patients newly treated for hypertension during an 18-month period was categorized into monotherapy, sequential monotherapy, stepped care, and initial treatment with multiple agents. With monotherapy, the class of medication was also reported. Associations between use of angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, or β-blockers and presence of comorbid conditions were reported.

Results: Fifty-five percent of patients received monotherapy, 22 percent received stepped care, and 18 percent received sequential monotherapy. Of those 208 patients receiving monotherapy, 30 percent were prescribed a calcium channel blocker, 22 percent an ACE inhibitor, and 14 percent a β-blocker. No customization of treatment for comorbid conditions was noted.

Conclusions: Physicians attempt to treat patients’ hypertension with monotherapy. In the majority of cases, they have used either a calcium channel blocker or ACE inhibitor as initial monotherapy. Costs for treating hypertension could be reduced and care improved if thiazide diuretics, a combination of potassium-sparing and thiazide diuretics, or β-blockers were used more frequently as initial monotherapy.

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The Journal of the American Board of Family     Practice: 8 (1)
The Journal of the American Board of Family Practice
Vol. 8, Issue 1
1 Jan 1995
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Initial Medication Selection For Treatment Of Hypertension In An Open-Panel HMO
Micky Jerome, George C. Xakellis, Greg Angstman, Wayne Patchin
The Journal of the American Board of Family Practice Jan 1995, 8 (1) 1-6; DOI: 10.3122/jabfm.8.1.1

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Initial Medication Selection For Treatment Of Hypertension In An Open-Panel HMO
Micky Jerome, George C. Xakellis, Greg Angstman, Wayne Patchin
The Journal of the American Board of Family Practice Jan 1995, 8 (1) 1-6; DOI: 10.3122/jabfm.8.1.1
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