Background The frequency of the prescriptions of different drug classes in hypertension is the result of a number of factors. The impact of the hypertension treatment guidelines, as a balanced combination of the evidence-based medicine and opinions of experts, definitely should be the greatest. There are no studies assessing the universality of the usage of the rule of individualization of the antihypertensive therapy by the comparison of the treatment pattern in non-complicated hypertension with the treatment in hypertension with the accompanying disease or complication.
The aim of the study was to compare the frequency of prescriptions of different classes of antihypertensive drugs in patients with coexisting ischaemic heart disease or without that coexistence.
Material and methods Data of 15 056 patients from the questionnaires filled by general practitioners were analyzed. The diagnosis of hypertension and/or ischaemic heart disease was the inclusion criterion. In adequate questionnaires relating hypertension and/or ischaemic heart disease questions about the demographic data, the diagnosis, previous treatment, current symptoms, blood pressure values measured during the visit, reasons and the modification of treatment were included.
Results Beta-blockers were the most frequently used class of drugs (3409 patients - 58.1%) in the group of hypertensive patients, they were used with the same frequency in patients with the coexisting of the ischaemic heart disease (2981 patients - 60.0%). Angiotensine converting enzyme inhibitors (ACE I) were prescribed to 2966 hypertensive patients (50.6%), while in the class with coexisting ischaemic heart disease - to 3796 patients (76.4%), what makes them the most frequently used class of drugs in these patients. Diuretics were used in 1927 patients (32.9%) with hypertension, and even more frequently in patients with hypertension and ischaemic heart disease (2355 - 47.4%). Similarly, calcium antagonists were prescribed to 15.8% of hypertensive patients and 24.0% of patients with hypertension and ischaemic heart disease (47.3%). In case of ineffectiveness treatment beta-blockers were the most frequently added hypotensive drugs in patients with hypertension (66.1%) as well as in patients with coexistence of the ischaemic heart disease (47.3%).
Conclusions 1. Beta-blockers and angiotensine converting enzyme inhibitors are the most frequently used hypotensive drugs independently of the coexistence of the ischaemic heart disease.
2. In hypertensive patients with concomitant ischaemic heart discase angiotensine converting enzyme inhibitors, diuretics and calcium antagonists were used with more frequently than in patients with non-complicated hypertension, while the coesistance of ischaemic heart disease had no impact on the frequency of the beta-blockers prescriptions.
3. The current recommendations of the Polish Society of Hypertension (PTNT) and the Polish Cardiac Society (PTK) concerning the individualization of the antihypertensive therapy in patients with concomitant ischaemic heart disease are not widely followed.