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Antihypertensive doses inadequate in majority of patients

By Nigel Praities

Most patients on antihypertensive drugs are being prescribed too low a dose, claim UK researchers.

An audit of 60 emergency admissions to the City Hospital, in Birmingham, found that of those patients taking angiotensin-receptor blockers or ACE inhibitors, 62% were receiving ‘sub-optimal' doses of the drugs.

Some of the lowest doses were seen in patients taking ARBs or ACE-inhibitors for ischaemic heart disease and hypertension, who were taking an average of 39% of the recommended top dose as recommended in the BNF or used in clinical trials.

The researchers said they were concerned about the degree of sub-optimal dosing for blood pressure, which was partly due to GPs not up-titrating their patients or losing them to follow-up.

‘This is likely to result in patients not receiving the complete therapeutic benefit from these agents and reducing their cost-effectiveness,' they said.

Dr Gerald Partridge, a GP in Keighley, West Yorkshire, and CHD lead at Airedale PCT, defended GP prescribing and warned the results came from a specialist perspective.

‘GPs are not expecting to get patients onto the top doses, without a degree of trouble.

‘They are looking through the blinkers of their own speciality and not in the real world where people have co-morbid conditions. They may have a bit of a point, but I don't think they are making a definitive statement by a long way,' he said.

The study appears in the latest edition of the British Journal of Cardiology.

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