ArticleJournal of human hypertension2006
Between-country variation in the utilization of antihypertensive agents: Guidelines and clinical practice.
Article in Journal of human hypertension, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Hypertension Management in Brazil: Usual Practice in Primary Care-A Meta-Analysis.International journal of hypertension · 2017Review
- [Use of prescription drugs in Spain and Europe].Atencion primaria · 2012Review
- Change in antihypertensive drug prescribing after guideline implementation: a controlled before and after study.BMC family practice · 2011Article
- Introducing candesartan 32 mg plus hydrochlorothiazide 25 mg in previously untreated patients with severe essential hypertension.Pragmatic and observational research · 2011Article
- A global perspective on blood pressure treatment and control in a referred cohort of hypertensive patients.Journal of clinical hypertension (Greenwich, Conn.) · 2010Article
- [Is "evidence-based medicine" followed by "confidence-based medicine"?].Medizinische Klinik (Munich, Germany : 1983) · 2010Review
- No difference in between-country variability in use of newly approved orphan and non- orphan medicinal products--a pilot study.Orphanet journal of rare diseases · 2009Article
- Blood pressure control in hypertensive patients in Irish primary care practices.Journal of clinical hypertension (Greenwich, Conn.) · 2009Article
- Management of hypertension with fixed dose combinations of candesartan cilexetil and hydrochlorothiazide: patient perspectives and clinical utility.Vascular health and risk management · 2009Review
- Managing cardiovascular risk: the need for change.Journal of human hypertension · 2008Article
- Hypertension in the elderly: a compelling contraindication for beta-blockers?Journal of human hypertension · 2007Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Variation in antihypertensive drug utilization and guideline preferences between six European countries (Denmark, Finland, Germany, Norway, Sweden, the Netherlands) was investigated. Our objectives were to compare between-country variability in utilization per class of antihypertensive agents and to assess guideline preferences in relation to actual use. Antihypertensive consumption data (2003) was retrieved. We classified antihypertensive agents using ATC-codes: C02CA - alpha-blockers (AB), C03A - thiazide diuretics (TD), C07AB - beta-blockers (BB), C08CA - dihydropyridine calcium antagonists (CA), C09A/C09BA/C09BB - ACE-inhibitors+combinations (AI) and C09C/C09D - angiotensin II receptor blockers+combinations (AT2). For each class, DDDs/1000 persons/day and share (%) of total antihypertensive utilization was calculated. Per class, relative standard deviations (RSD) across countries were computed. Current hypertension guidelines were requested from national medical associations. Total antihypertensive utilization varied considerably, ranging from 152.4 (Netherlands) to 246.9 (Germany) DDDs/1000 persons/day. RSD was highest for TD (106.2%) and AB (93.6%). Where guidelines advocated TDs (Norway and Netherlands), TD utilization was below (Norway) or just above (Netherlands) median TD use. Guidelines recommended TD (Norway and Netherlands), TD/BB/AI (Finland, German Physicians Association) or TD/BB/CA/AI/AT2 (Denmark, German Hypertension Society), Sweden had no recent national guideline. In conclusion, antihypertensive utilization patterns varied largely across these six countries, in absolute and relative terms. Furthermore, guidelines seem disconnected from clinical practice in some countries, and none of the guidelines discuss current utilization. Whether this reflects a need for change in prescribing or re-evaluation of guidelines warrants further research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.