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

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 antihypersentive 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 me have a higher absolute risk of coronary heart disease that 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.