Media Background Contact: Mark Naples 202/955-6222 Study of Hypertension Prescribing Practices (SHyPP)
To assess treatment recommendations of primary care physicians in light of new guidelines, new data, and changes in the prescribing environment.
Survey Sample Ä National random sample of 600 primary care physicians. Ä Forty percent response rate. Ä Detailed survey instrument on treatment recommendations and practice environment.
JNC-V Recommendations
Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V) recommended four steps for treatment of hypertension:
* Modify lifestyle;
* Add pharmacological agent (diuretic or beta blockers preferred);
* Increase drug dose, substitute other drug, or add a second class;
* Add a second or third agent and/or diuretic, if not already prescribed.
Physician Awareness of JNC-V Guidelines
* 29 percent of respondents not aware of the guidelines.
* Of those aware, only 3 percent report always following them, 53 percent report following them often, and 35 percent report following them sometimes or rarely.
Physician Choices for New Antihypertensive Treatment
Top Choice Top 3 Choices
ACE Inhibitor: 36% 85%
Diuretics: 34% 70%
Beta Blockers: 15% 62%
Calcium-Channel Blockers: 8% 53%
Treatment Parameters
Treat at Greater Than Males Females
SBP 140 24% 25%
150 47% 33%
160 24% 31%
170 5% 10%
DBP 85 2% 4%
90 63% 60%
95 28% 25%
100 6% 11%
Cost Issues "What is the frequency with which patients complain about the cost of their hypertension medications?"
Always: 3%
Often: 39%
Sometimes: 45%
Rarely: 9%
(96% of patients complain about cost.)
Never: 1%
45 percent of respondents thought patients were more concerned about costs today than they were 18 months ago.
How much do physicians know about the cost of medications?
15 to 35 percent did not know the monthly costs of specific medications.
Cost of Antihypertensive agents:
Diuretics: $0.48 to $2.11
Beta Blockers: $0.02 to $1.24
ACE Inhibitors: $0.07 to $1.89
Calcium-Channel Blockers: $0.82 to $1.98
a-1 Blockers: $0.96 to $1.50
Effect of Formulary Programs
59 percent of physicians believed treatments were affected by formulary programs.
30 percent believed managed care formulary recommendations were not guided by JNC-V guidelines.
Summary
* A substantial portion of primary care physicians were unaware of, or elect not to follow JNC-V treatment guidelines for hypertension.
* Treatment recommendations for hypertension favored ACE inhibitors - more marketed products - over less-marketed diuretics and beta blockers.
While patients complain about the cost of medications, physicians were unaware of the costs or underestimated the costs of products which actually cost their patients more.
Complete SHyPP results will be released at the conclusion of the survey this fall.
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