Gender, age and deprivation differences in the primary care management of hypertension in Scotland: a cross-sectional database study

Background. Little is known about the community management of cardiovascular disease among different gender, age or deprivation groups, even though much of the long-term treatment takes place within primary care. Objectives. Our aim was to determine whether important gender, age and deprivation differences exist in the primary care management of hypertension. Methods. A cross-sectional analysis of computerized general practice data was carried out in 43 practices in Scotland contributing to the Continuous Morbidity Recording project. The main outcome measures were odds ratios of being under GP review; receiving different classes of anti hypertensive treatments [thiazides, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers]; and receiving other cardiovascular preventative treatments (statins and/or antiplatelets). Results. Compared with males, female hypertensive patients were more likely to receive a thiazide and less likely to be given an ACE inhibitor, calcium channel blocker or secondary preventative treatment. Elderly hypertensive patients were less likely than the youngest patients to be under GP active review, more likely to be on a thiazide, calcium channel blocker or antiplatelet treatment, and less likely to be on a statin. More deprived hypertensive patients were less likely to be under GP review, or to be on a thiazide or a statin, but were more likely to be on a calcium channel blocker or an antiplatelet drug than the most affluent group. Conclusions. Important gender, age and deprivation differences exist in three important components of the primary care treatment of hypertension in Scotland.