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Sex differences in the medication choice for hypertension in general practice. A study with written case simulations

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Abstract

The objective of this study was to explore explanations for the preference of physicians to prescribe β‐blockers to hypertensive men and diuretics to hypertensive women.A qualitative study among 12 family physicians was conducted with a combination of written case simulations, semi‐structured interviews and statements on attitudes of physicians towards antihypertensive drug choice.Among the male hypertensive cases the most frequently prescribed drugs were β‐blockers, whereas among the female hypertensive cases diuretics were more often prescribed. Physician characteristics associated with a preferred prescribing of β‐blockers to hypertensive men and diuretics to hypertensive women were: older age (no residency in family medicine), the believe that β‐blockers are more effective in men with regard to lowering blood pressure and that diuretics are more effective in women, a non‐evidence based attitude and a sex‐related attitude towards the choice of β‐blockers and diuretics in general, and in particular towards the prescribing of β‐blockers to hypertensive men because men have a higher absolute risk of coronary heart disease than women. An additional explanation for these findings may be the higher prevalence of ankle oedema among women. Patient characteristics associated with more prescribing of β‐blockers to hypertensive men and diuretics to hypertensive women were: current employment and a "high‐risk" profile in terms of blood pressure level and additional cardiovascular risk factors.Although, most considerations underlying a preferred prescribing of β‐blockers to hypertensive men and diuretics to hypertensive women were not evidence‐based, the actual choice of antihypertensive drug (diuretic or β‐blocker) was evidence‐based. These considerations may also play a role in the sex difference in the choice of calcium antagonists and angiotensin converting enzyme inhibitors and require further investigation.

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Authors and Affiliations

  1. Department of Pharmacoepidemiology & Pharmacotherapy, Faculty of Pharmacy, Universiteit Utrecht, Sorbonnelaan 16, 3508 TB, Utrecht, The Netherlands

    Olaf H. Klungel

  2. Department of Pharmacoepidemiology & Pharmacotherapy, Faculty of Pharmacy, Universiteit Utrecht, Sorbonnelaan 16, 3508 TB, Utrecht, The Netherlands

    Arsenio H.P. Paes, Anthonius de Boer & Albert Bakker

  3. Department of General Practice, Utrecht Medical Centre Utrecht (UMCU), Netherlands

    Marijke M. Kuyvenhoven

  4. Department of Chronic Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands

    Jacob C. Seidell

Authors
  1. Olaf H. Klungel
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  2. Arsenio H.P. Paes
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  3. Anthonius de Boer
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  4. Marijke M. Kuyvenhoven
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  5. Jacob C. Seidell
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  6. Albert Bakker
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Klungel, O.H., Paes, A.H., de Boer, A. et al. Sex differences in the medication choice for hypertension in general practice. A study with written case simulations. Pharm World Sci 22, 140–146 (2000). https://doi.org/10.1023/A:1008713714549

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