Evaluation of the agreement between guidelines and initial antihypertensive drug treatment using a national health care reimbursement database
Article first published online: 30 JAN 2011
© 2011 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Volume 18, Issue 3, pages 623–629, June 2012
How to Cite
Meneton, P., Ricordeau, P., Weill, A., Tuppin, P., Samson, S., Allemand, H., Durieux, P. and Ménard, J. (2012), Evaluation of the agreement between guidelines and initial antihypertensive drug treatment using a national health care reimbursement database. Journal of Evaluation in Clinical Practice, 18: 623–629. doi: 10.1111/j.1365-2753.2011.01640.x
- Issue published online: 8 MAY 2012
- Article first published online: 30 JAN 2011
- Accepted for publication: 22 December 2010
- French population;
- initial drug treatment;
- national health care reimbursement database
Rationale, aims and objectives To test the agreement between guidelines for the management of hypertension and medical practices while avoiding frequent limitations such as the use of non-representative samples of practitioners and self-reporting of their practices over a short period of time.
Methods The characteristics of initial antihypertensive drug treatment in a large representative sample of the French population aged 50–80 (n = 17 855) were collected from a national health care reimbursement database and compared with national guidelines over a 5-year period.
Results Major discrepancies are observed including the use of non-recommended drug classes such as loop and potassium sparing diuretics alone or in association and the absence of distinction between patients according to their age. More minor discrepancies are the preferential use of mono-therapies over drug combinations and of some bi-therapies among those recommended. Some degree of concordance with the guidelines is also observed including the specific characteristics of the treatment of diabetics compared with other categories of patients and the preferential use of long-acting dihydropyridine calcium antagonists and of low-dose thiazide diuretics when these drug classes are chosen. Several of these discrepancies or concordances, which mainly reflect general practitioner (GP) activity, show time trends over the entire follow-up period with no significant effect of the guideline released during this period.
Conclusions At the French national level, the agreement between initial antihypertensive drug treatment and guidelines varies considerably depending on the characteristics of the treatment that are considered. The GPs who delivered the treatment do not seem to have been influenced by the guidelines released over the last decade.