PT  - JOURNAL ARTICLE
AU  - Jerome, Micky
AU  - Xakellis, George C.
AU  - Angstman, Greg
AU  - Patchin, Wayne
TI  - Initial Medication Selection For Treatment Of Hypertension In An Open-Panel HMO
AID  - 10.3122/jabfm.8.1.1
DP  - 1995 Jan 01
TA  - The Journal of the American Board of Family
                Practice
PG  - 1--6
VI  - 8
IP  - 1
4099  - http://www.jabfm.org/content/8/1/1.short
4100  - http://www.jabfm.org/content/8/1/1.full
SO  - J Am Board Fam Med1995 Jan 01; 8
AB  - 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.