A pharmacy prescription database was used to identify patients at high risk for drug-related problems. Of the 1054 patients in the study, 687 had a diagnosis of hypertension. The utilization of antihypertensive medications was captured at three periods over 24 months (12 months before enrollment, at enrollment, and 12 months after enrollment). The diagnosis of hypertension and coexisting diseases were identified at enrollment. There were 238 (34.6%) with diabetes, 333 (48.5%) with coronary artery disease, 64 (9.3%) with congestive heart failure, and 244 (35.5%) with none of these coexisting conditions. At Period 3, 44.7% of patients without coexisting diseases received calcium channel blockers, followed closely by diuretics (41.4%). Calcium channel blockers were used significantly more frequently than any other drug category for these patients (p less than 0.05). For patients with hypertension and diabetes, ACE inhibitors were used by 62%, and this was significantly more frequently than any other category (p less than 0.03). Diuretics (52.1%) were utilized significantly more frequently than calcium channel blockers (42.9%) (p less than 0.043). For patients with hypertension and congestive heart failure, diuretics were utilized significantly more than any other category (70.3%, p less than 0.03), and ACE inhibitors were utilized significantly more often than any other category except diuretics (68.8%, p less than 0.0001). This study examined antihypertensive utilization in specific patients (rather than as a function of total drugs), making the results different from those of previous reports. This study demonstrates better adherence to recommended guidelines than previous studies have suggested. While Beta blockers and diuretics were utilized frequently in these patients, statistics suggest that there is still room for improvement in the utilization of these important drugs. This paper describes the utilization of antihypertensive medications in nine Veterans Affairs Medical Centers. (c)2000 by Le Jacq Communications, Inc.

OBJECTIVE: To evaluate the effects of an intensive intervention to implement guidelines for cost-effective management of hypertension on medication use and cost, blood pressure control, and other resource use.

OBJECTIVE Verapamil has been associated with hyperprolactinaemia, but there have been no population‐based studies. Our objective was to determine the prevalence and degree of hyperprolactinaemia associated with verapamil in the clinical setting. DESIGN Observation with cross‐sectional and longitudinal components in the setting of an urban teaching hospital and its satellite out‐patient clinics. PATIENTS Male out‐patients excluding those taking other drugs known to raise PRL, renal failure and known primary hypothyroidism (1265 eligible subjects). Control subjects were drawn from eligible out‐patients not taking verapamil. MEASUREMENTS Serum PRL levels, frequency of persistent hyperprolactinaemia and total testosterone levels. RESULTS Prolactin levels were obtained in 449 subjects on verapamil (35.5% response rate) and 166 controls. The proportions of individuals with hyperprolactinaemia (PRL > 460 mU/l) were 0.085 and 0.030 in the verapamil and control groups, respectively (P = 0.012, χ2‐test). The mean (±SD) serum PRL levels were 267 ± 205 and 203 ±118 mU/l in the verapamil and control groups, respectively (P < 0.001, independent t‐test). Of the 38 patients with previously determined elevated PRL levels, follow‐up data were obtained in 25 (65.8%); one was found to have a pituitary adenoma and was excluded from the analysis. Fifteen of the 24 were still on verapamil (Group 1) and 14 (93.3%) continued to be hyperprolactinaemic. In 9 patients verapamil had been discontinued (Group 2) and all had normal PRL levels. Continued verapamil use was associated with persistent hyperprolactinaemia (odds ratio > 120, P < 0.00001). The ± SD serum testosterone levels at follow‐up were significantly lower in Group 1 (6.16 ± 2.52 nmol/l) than in Group 2 (9.42 ± 3.92 nmol/l, P = 0.029, independent t‐test). CONCLUSIONS The prevalence of hyperprolactinaemia associated with verapamil use in this study of male out‐patients was .5% (95% Cl 5.9–11.1%). The persistence of hyperprolactinaemia when verapamil was continued (Group 1) and the return to normal PRL levels when verapamil was discontinued (Group 2) confirm verapamil’s causal role in the development of hyperprolactinaemia. While low testosterone levels were common in both groups, testosterone levels were lower in patients on verapamil. Our data suggest that screening for hyperprolactinaemia should be considered in male patients taking verapamil.

Objective: To describe a patient with an incidental pituitary lesion who experienced verapamil-induced hyperprolactinemia. Case Summary: A patient experiencing impotence was found to have increased prolactin and low testosterone concentrations. Verapamil as a cause for his increased prolactin concentration was not considered initially. The patient underwent extensive testing to rule out a pituitary tumor. Magnetic resonance imaging showed a 6-mm lesion consistent with a pituitary microadenoma that had remained unchanged for 6 months. Verapamil therapy was discontinued and within 1 month the patient's prolactin concentration decreased from 46.8 to 14.4 μg/L, and has remained within normal limits. Discussion: We reviewed reports of verapamil-induced hyperprolactinemia. This case was unique as this patient had an incidental pituitary lesion that was not responsible for increasing the prolactin concentration in our patient, but rather complicated the identification of a drug-induced disorder. Conclusions: The failure to identify the hyperprolactinemic effect of verapamil may have resulted in performing unnecessary radiologic procedures in this patient This case highlights the importance of obtaining a medication history in patients with hyperprolactinemia.