Diuretics for hypertension-an inconsistency in primary care prescribing behaviour

Thomas Kuehlein, Gunter Laux, Andreas Gutscher, Katja Goetz, Joachim Szécsényi, Stephen Campbell, Jost Steinhaeuser

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective:
Internationally there is an ongoing debate on diuretics as first-line therapy for most patients with hypertension. In spite of many arguments against them in antihypertensive monotherapy, the authors of the present study perceived them to be regularly prescribed in combination therapy in Germany. The study objective was to look for this discrepancy in prescribing reality as a contribution from clinical practice to an academic debate.

Methods:
A descriptive cross-sectional study in a yearly contact group (YCG; 1.7.2007–31.06.2008) was conducted based on data from a scientific network of 22 general practitioners in Germany. All patients with hypertension as diagnosed by their general practitioner were included. Antihypertensives were grouped according to the ATC classification. To assess for potential design effects by the given two-level setting, 95% confidence intervals (CI) were adjusted for clustering.

Results:
Hypertension had been diagnosed in 9.3% of the 58 852 patients. Of these, 21.6% received no antihypertensives. Of those who were treated, 30.6% (CI [28.6–32.6]) had monotherapy. In monotherapy, 8.6% (CI [7.1–10.2]) were prescribed some diuretic, 1.5% (CI [0.5–3.0]) received hydrochlorothiazide (HCT). Combination therapy was prescribed to 69.4% (CI [67.2–71.6]). These patients received some diuretic in 79.0% (CI [76.9–81.0]) of the cases, of which 80.8% (CI [78.5–83.1]) had a combination with HCT. HCT was prescribed in 76.2% (CI [73.5–78.9]) in fixed-dose formulations.

Conclusion:
In spite to the many arguments against them, leading to their almost complete disregard in monotherapy, thiazide-diuretics seem to be standard in combination therapy in Germany. This inconsistency can not be explained by the arguments of the current debate. Key limitations of the present study include the lack of ability to tell whether a given monotherapy is the first-line medication, the small sample size and the possible selection bias
Original languageEnglish
Pages (from-to)497-502
Number of pages6
JournalCurrent Medical Research and Opinion
Volume27
Issue number3
DOIs
Publication statusPublished - 2011
Externally publishedYes

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Diuretics
Primary Health Care
Confidence Intervals
Hypertension
Hydrochlorothiazide
Antihypertensive Agents
Germany
General Practitioners
Sodium Chloride Symporter Inhibitors
Selection Bias
Therapeutics
Sample Size
Cluster Analysis
Cross-Sectional Studies

Cite this

Kuehlein, T., Laux, G., Gutscher, A., Goetz, K., Szécsényi, J., Campbell, S., & Steinhaeuser, J. (2011). Diuretics for hypertension-an inconsistency in primary care prescribing behaviour. Current Medical Research and Opinion, 27(3), 497-502. https://doi.org/10.1185/03007995.2010.547932
Kuehlein, Thomas ; Laux, Gunter ; Gutscher, Andreas ; Goetz, Katja ; Szécsényi, Joachim ; Campbell, Stephen ; Steinhaeuser, Jost. / Diuretics for hypertension-an inconsistency in primary care prescribing behaviour. In: Current Medical Research and Opinion. 2011 ; Vol. 27, No. 3. pp. 497-502.
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abstract = "Objective:Internationally there is an ongoing debate on diuretics as first-line therapy for most patients with hypertension. In spite of many arguments against them in antihypertensive monotherapy, the authors of the present study perceived them to be regularly prescribed in combination therapy in Germany. The study objective was to look for this discrepancy in prescribing reality as a contribution from clinical practice to an academic debate.Methods:A descriptive cross-sectional study in a yearly contact group (YCG; 1.7.2007–31.06.2008) was conducted based on data from a scientific network of 22 general practitioners in Germany. All patients with hypertension as diagnosed by their general practitioner were included. Antihypertensives were grouped according to the ATC classification. To assess for potential design effects by the given two-level setting, 95{\%} confidence intervals (CI) were adjusted for clustering.Results:Hypertension had been diagnosed in 9.3{\%} of the 58 852 patients. Of these, 21.6{\%} received no antihypertensives. Of those who were treated, 30.6{\%} (CI [28.6–32.6]) had monotherapy. In monotherapy, 8.6{\%} (CI [7.1–10.2]) were prescribed some diuretic, 1.5{\%} (CI [0.5–3.0]) received hydrochlorothiazide (HCT). Combination therapy was prescribed to 69.4{\%} (CI [67.2–71.6]). These patients received some diuretic in 79.0{\%} (CI [76.9–81.0]) of the cases, of which 80.8{\%} (CI [78.5–83.1]) had a combination with HCT. HCT was prescribed in 76.2{\%} (CI [73.5–78.9]) in fixed-dose formulations.Conclusion:In spite to the many arguments against them, leading to their almost complete disregard in monotherapy, thiazide-diuretics seem to be standard in combination therapy in Germany. This inconsistency can not be explained by the arguments of the current debate. Key limitations of the present study include the lack of ability to tell whether a given monotherapy is the first-line medication, the small sample size and the possible selection bias",
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Kuehlein, T, Laux, G, Gutscher, A, Goetz, K, Szécsényi, J, Campbell, S & Steinhaeuser, J 2011, 'Diuretics for hypertension-an inconsistency in primary care prescribing behaviour', Current Medical Research and Opinion, vol. 27, no. 3, pp. 497-502. https://doi.org/10.1185/03007995.2010.547932

Diuretics for hypertension-an inconsistency in primary care prescribing behaviour. / Kuehlein, Thomas; Laux, Gunter; Gutscher, Andreas; Goetz, Katja; Szécsényi, Joachim; Campbell, Stephen; Steinhaeuser, Jost.

In: Current Medical Research and Opinion, Vol. 27, No. 3, 2011, p. 497-502.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diuretics for hypertension-an inconsistency in primary care prescribing behaviour

AU - Kuehlein, Thomas

AU - Laux, Gunter

AU - Gutscher, Andreas

AU - Goetz, Katja

AU - Szécsényi, Joachim

AU - Campbell, Stephen

AU - Steinhaeuser, Jost

PY - 2011

Y1 - 2011

N2 - Objective:Internationally there is an ongoing debate on diuretics as first-line therapy for most patients with hypertension. In spite of many arguments against them in antihypertensive monotherapy, the authors of the present study perceived them to be regularly prescribed in combination therapy in Germany. The study objective was to look for this discrepancy in prescribing reality as a contribution from clinical practice to an academic debate.Methods:A descriptive cross-sectional study in a yearly contact group (YCG; 1.7.2007–31.06.2008) was conducted based on data from a scientific network of 22 general practitioners in Germany. All patients with hypertension as diagnosed by their general practitioner were included. Antihypertensives were grouped according to the ATC classification. To assess for potential design effects by the given two-level setting, 95% confidence intervals (CI) were adjusted for clustering.Results:Hypertension had been diagnosed in 9.3% of the 58 852 patients. Of these, 21.6% received no antihypertensives. Of those who were treated, 30.6% (CI [28.6–32.6]) had monotherapy. In monotherapy, 8.6% (CI [7.1–10.2]) were prescribed some diuretic, 1.5% (CI [0.5–3.0]) received hydrochlorothiazide (HCT). Combination therapy was prescribed to 69.4% (CI [67.2–71.6]). These patients received some diuretic in 79.0% (CI [76.9–81.0]) of the cases, of which 80.8% (CI [78.5–83.1]) had a combination with HCT. HCT was prescribed in 76.2% (CI [73.5–78.9]) in fixed-dose formulations.Conclusion:In spite to the many arguments against them, leading to their almost complete disregard in monotherapy, thiazide-diuretics seem to be standard in combination therapy in Germany. This inconsistency can not be explained by the arguments of the current debate. Key limitations of the present study include the lack of ability to tell whether a given monotherapy is the first-line medication, the small sample size and the possible selection bias

AB - Objective:Internationally there is an ongoing debate on diuretics as first-line therapy for most patients with hypertension. In spite of many arguments against them in antihypertensive monotherapy, the authors of the present study perceived them to be regularly prescribed in combination therapy in Germany. The study objective was to look for this discrepancy in prescribing reality as a contribution from clinical practice to an academic debate.Methods:A descriptive cross-sectional study in a yearly contact group (YCG; 1.7.2007–31.06.2008) was conducted based on data from a scientific network of 22 general practitioners in Germany. All patients with hypertension as diagnosed by their general practitioner were included. Antihypertensives were grouped according to the ATC classification. To assess for potential design effects by the given two-level setting, 95% confidence intervals (CI) were adjusted for clustering.Results:Hypertension had been diagnosed in 9.3% of the 58 852 patients. Of these, 21.6% received no antihypertensives. Of those who were treated, 30.6% (CI [28.6–32.6]) had monotherapy. In monotherapy, 8.6% (CI [7.1–10.2]) were prescribed some diuretic, 1.5% (CI [0.5–3.0]) received hydrochlorothiazide (HCT). Combination therapy was prescribed to 69.4% (CI [67.2–71.6]). These patients received some diuretic in 79.0% (CI [76.9–81.0]) of the cases, of which 80.8% (CI [78.5–83.1]) had a combination with HCT. HCT was prescribed in 76.2% (CI [73.5–78.9]) in fixed-dose formulations.Conclusion:In spite to the many arguments against them, leading to their almost complete disregard in monotherapy, thiazide-diuretics seem to be standard in combination therapy in Germany. This inconsistency can not be explained by the arguments of the current debate. Key limitations of the present study include the lack of ability to tell whether a given monotherapy is the first-line medication, the small sample size and the possible selection bias

U2 - 10.1185/03007995.2010.547932

DO - 10.1185/03007995.2010.547932

M3 - Article

VL - 27

SP - 497

EP - 502

JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 0300-7995

IS - 3

ER -