A Michigan study published in the journal
Pediatrics reveals that race differences exist in physicians' prescribing of
drugs to adolescents with hypertension. White
adolescents are more likely to receive anti-hypertensive medication compared
with black subjects.
Under-treatment or delay in the
treatment of hypertension in black subjects, as
reflected by the findings, warrant attention.
It was also found that adult primary care physicians (PCPs) appear to be the ones mostly
prescribing antihypertensive medications to adolescents rather than
pediatricians. Two-thirds of those teens received their prescriptions from
Primary hypertension or essential hypertension,
i.e. high blood pressure with no known cause, is rampant in the adolescent age
group, especially in America, and is of great concern to physicians since it is
associated with the growing obesity epidemic. Despite this known fact, little
has been described about medical management of primary hypertension in
adolescents. The recent study describes patterns
of antihypertensive prescribing for adolescents
with the disease.
Antihypertensive medications are recommended
for adolescents with persistent hypertension despite lifestyle modifications.
If treatment using a single class of drugs (monotherapy) doesn't help to
achieve the desired goals, then combination therapy is resorted to. Such a need for combination regimen
increased disease severity.
For this study, 4,296 adolescents with primary
hypertension were identified during 2003 to 2008. 66 percent of these were
boys; 73 percent were aged 11 to 14 years; 48 percent had obesity-related
comorbidity; and 53, 41, and 4 percent were blacks, whites, and Hispanics,
respectively. More than one-quarter of the antihypertensive adolescents
receive combination therapy.
Startling racial differences with respect to
treatment were uncovered.
differences exist in physicians' prescribing of anti-hypertensives. White
adolescents were significantly more likely to receive antihypertensive drugs
compared with black subjects. Black
subjects may hence suffer under-treatment or
delay in treatment for primary hypertension.
increased use of combination therapy in black subjects was also revealed by the
adolescents with primary hypertension have
higher risk of heart diseases compared with non-black adolescents. This may be
the rationale for the aggressive blood pressure control using multiple classes
of drugs in black adolescents.
- Primary care physicians or the PCPs, who
treat mostly adults, include family physicians, general practitioners,
internists, and joint internal medicine-pediatrics specialists. According to
this study, it appears that PCPs, rather than paediatricians, are the one who
do most of the antihypertensive combination therapy prescriptions for
adolescents. Maybe clinicians who are used to manage high blood pressure in
adults are more likely to be alarmed by hypertension in adolescents. They may
also be more familiar to antihypertensive drugs than pediatricians. These are
the plausible explanations for the fact that nearly two-third of the antihypertensive
prescriptions for adolescents are by primary care
The researchers recommended further studies to be done to explore the
choice of antihypertensive
medication and to determine the effectiveness
of such treatment.
Reference: Antihypertensive Prescribing Patterns
for Adolescents With Primary Hypertension;
Esther Yoon et al; PEDIATRICS 2011.