Objectives: This study was conducted to examine perceptions, knowledge, and rationale for prescribing β-blockers among physicians who treat patients with hypertension.
Methods: In August/September 2016, 103 primary care physicians (PCPs) and 59 cardiologists participated in a 20-minute quantitative, online survey regarding their use and perceptions of β-blockers. Significant between-group differences were examined via t-tests and z-tests.
Results: Significantly more cardiologists chose β-blockers as first-line therapy than PCPs (30% vs 17%, P<0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. When choosing a β-blocker, cardiologists rated “impact on fatigue and energy” and “arterial vasodilation” as more important treatment features than PCPs (P<0.05 and P<0.01, respectively). Physicians’ awareness of vasodilation was greater for carvedilol (52% [84/162]) than nebivolol (31%[51/162]). A large proportion of cardiologists and PCPs were unaware that any β-blockers cause weight gain (cardiologists, 34%[20/59]; PCPs, 39%[40/103]) or increased glucose (42% each, cardiologists [25/59], PCPs [43/103]). Overall, physicians associated atenolol and metoprolol with weight gain and clinically relevant changes in glucose, while nebivolol was least associated with either outcome. Only 10% of cardiologists (6/59) and 2% of PCPs (2/103) associated carvedilol with weight gain (P<0.05). Among β-blocker features, nebivolol was closely associated with: β1-selectivity; efficacy in patients aged >60 years; efficacy in African-American patients; and arterial vasodilation. Metoprolol was closely associated with heart rate reduction, and atenolol was associated with heart rate reduction, fatigue, erectile dysfunction, and impact on mood. Physicians had a positive response to using drugs other than metoprolol or atenolol that could lower the risk of new onset diabetes for pre-diabetic or obese patients. Clinical practice guidelines influenced prescribing behaviors more than formulary or performance metrics; continuing medical education and publications were commonly accessed materials for hypertension education.
Conclusions: This survey highlights several educational gaps, including differences between PCPs and cardiologists, on the perceptions of β-blockers for hypertension treatment. Future efforts should include physician education on relevant evidence-based differences between β-blockers, given their heterogeneity.