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- W1850871037 abstract "HomeHypertensionVol. 37, No. 5Trends in Antihypertensive Drug Therapy by US Office-Based Physicians Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBTrends in Antihypertensive Drug Therapy by US Office-Based Physicians E. Andrew Balas E. Andrew BalasE. Andrew Balas Center for Health Care Quality, University of Missouri-Columbia, Columbia, Missouri Search for more papers by this author Originally published1 May 2001https://doi.org/10.1161/01.HYP.37.5.e12Hypertension. 2001;37:e12To the Editor:We read with great interest the article by Nelson and Knapp1 on the trends of antihypertensive therapy by US office-based physicians. Their findings are clearly significant, but some of their conclusions are not supported by the data presented. The authors state that “physician antihypertensive drug prescribing was generally consistent with the basic antihypertensive drug guidelines of the JNC reports.” However, they also note that calcium channel blocker visits increased from 1.9% in 1985 to 39.8% in 1995 and that ACE inhibitor/receptor blocker visits increased from 6.4% to 37.0%, while all other drug classes decreased, including the JNC’s preferred step 1 agents of β-adrenergic blockers and diuretics. Moreover, while in 1995 monotherapy with either calcium channel blockers or ACE inhibitors together made up 39.5%, monotherapy with the JNC V’s preferred step 1 monotherapy of either diuretics or β-adrenergic blockers accounted for only 19.6% of antihypertensive drug visits.1 This is much more in accordance with the findings of previous studies in the United States2 and Europe,34 which found no effect of prescription guidelines on antihypertensive therapy by physicians. The profound increase in newer, expansive, patented products such as calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers seen in this and other studies has been attributed to the effect of intense promotion by drug manufacturers.35 One can only wonder why doctors do not follow recommendations by their professional organizations but rather the promotion campaigns of pharmaceutical companies, and what could be done to change this unfavorable situation. References 1 Nelson CR, Knapp DA. Trends in antihypertensive drug therapy of ambulatory patients by US office-based physicians. Hypertension.2000; 36:600–603.CrossrefMedlineGoogle Scholar2 Siegel D, Lopez J. Trends in antihypertensive drug use in the United States: do the JNC V recommendations affect prescribing? Fifth Joint National Commission on the Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 997;278:1745–1748.Google Scholar3 Szekacs B, Vajo Z, Szepezdi Z. Diuretics for hypertension JAMA..1999; 282:524.Google Scholar4 Jabary NS, Herrero AM, Gonzalez JA. The use of antihypertensive therapy in Spain (1986–1994). Am J Hypertens.2000; 13:607–610.CrossrefMedlineGoogle Scholar5 Moser M. Why are physicians not prescribing diuretics more frequently in the management of hypertension? JAMA.1998; 279:1813–1816.CrossrefMedlineGoogle ScholarhypertensionahaHypertensionHypertensionHypertension0194-911X1524-4563Lippincott Williams & WilkinsResponseNelson Cheryl R. and Knapp Dee A.052001Clearly, what is needed to address your concerns is a better explanation of what we meant by “basic antihypertensive drug guidelines of the JNC reports.” What we meant as “basic” is any of the “initial” step 1 antihypertensive drug classes as given in JNC V (Table 7) and JNC VI (Figure 8) (see our article for references). eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails May 2001Vol 37, Issue 5 Advertisement Article InformationMetrics https://doi.org/10.1161/01.HYP.37.5.e12 Originally publishedMay 1, 2001 PDF download Advertisement" @default.
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