The Impact of JNC-7 and New Clinical Studies on Antihypertensive Drug Prescribing

Abstract

Objectives: The objectives of this study were to assess the number of antihypertensive prescriptions by therapeutic class including beta-blockers, calcium channel blockers (CCBs), diuretics, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs), dispensed in the fiscal years 2002 through 2004. Methods: The project was a retrospective analysis of pharmacy data for medications used to treat hypertension from October 2002 through December 2004 (FY02 through the first quarter of FY05). Drug classes used to treat hypertension were obtained from the VA Integrated Service Network 18 (VISN 18). Within the drug classes, only drugs within the class having at least 100 prescriptions were included for the class. Rates of prescriptions dispensed by quarter over the three-year period of interest were obtained. Descriptive statistics were used to compare the before and after ALLHAT and JNC-7 time periods. Results: After the publication of The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), The Australian National Blood Pressure Study 2 (ANBP2), and Joint National Committee (JNC-7) guidelines, dihydropyridine CCB use declined to from 1.80% to 1.65% and non-dihydropyridine CCB use declined from 0.99% to 0.83% of all prescriptions from the first quarter 2002 to the first quarter 2004. In addition, after the publication of ALLHAT, hydrochlorothiazide use increased from 1.42% to 1.83% and ACE-inhibitor use increased from 4.26% to 4.79% of all prescriptions. Implications: The findings have several implications for encouraging our prescribing patterns to follow national guidelines and clinical studies more closely. Health care providers need to accept some responsibility through continuous education to be able to maintain appropriate therapy.