[Diuretics in the treatment of hypertension: critical analysis of opinions of general practitioners and cardiologists]. / Les diurétiques dans le traitement de l'hypertension artérielle: analyse critique de l'opinion des praticiens généralistes et cardiologues.

To better evaluate the clinical practice of French practitioners regarding the treatment of hypertension and the use of diuretics, we conducted a study using quota method to select 240 general practitioners and 90 cardiologists. Diuretics are still widely used and are effective well known drugs. Their use is nevertheless restricted by some side effects such as increasing frequency of micturition and electrolyte disturbances. These side effects are reduced with the new lower dosages and slow release formulations. Analysis of the results of our study suggests that the use of diuretics depends more on old habits and industry communication on drugs than on the knowledge of the results of therapeutic trials on mortality and morbidity.

[Hypertension associated with diabetes: inquiry into the attitudes and behaviors of French physicians]. / Hypertension associée au diabète: enquête sur les attitudes et les comportements des médecins français.

In order to assess the prevalence of arterial hypertension, diabetes mellitus, and of the association of both diseases, and furthermore, to underline the behaviours and feelings of French physicians in front of these combined diseases, a survey has been undertaken by the SOFRES Medical institute and by Laboratoires Hoechst, which involved 304 physicians in private practice and 67 hospital doctors. After face-to-face interviews, each participant had to fill up a questionnaire dealing with his general feelings and attitudes, and then completed 2 case record forms (5 cases for hospital doctors) from their last patients who presented with hypertension and diabetes mellitus. All these informations have allowed us to describe their behaviours. The 304 physicians have been selected with a regional stratification by a random survey quota method that gave a valid sample from the French medical population: 213 general practitioners (GPs), 67 cardiologists, 24 endocrinologists have been involved in the survey. They have been able to observe 149 hypertensive insulin-dependent diabetic patients and 470 hypertensive non insulin-dependent diabetic patients (respectively 24% and 76%). In addition, 67 hospital doctors (32 cardiologists, 17 diabetologists, 18 nephrologists) have been involved and have filled 255 case record forms (120 insulin-dependent and 135 non insulin-dependent diabetic patients). The association between hypertension and diabetes mellitus is very common: 55% out of the diabetic patients treated by GPs presented with hypertension, 20% out of the hypertensive patients presented with diabetes mellitus. The discovery of hypertension is usually followed by the discovery of non insulin-dependent diabetes mellitus. The opposite feature is observed for the insulin-dependent diabetic patients. The majority of the doctors feels that the cardiovascular prognosis of the association is worse than each single disease. The level of blood pressure that is suitable to start an antihypertensive treatment in hypertensive insulin-dependent and non insulin-dependent diabetic patients is generally lower than for non diabetic hypertensive patients, especially for the diabetologists. Concerning antihypertensive treatments, discrepancies have been observed in between feelings and behaviours of physicians. The class of drug that is thought to be used is obviously different from the one which is really used: angiotensin-converting enzyme inhibitors and calcium antagonists, two rather new classes of drugs are popular while classical classes of antihypertensive agents like diuretics and betablockers are still commonly used. Non pharmacological interventions which are useful for both the treatment of hypertension and diabetes mellitus are not commonly recommended by GPs and specialists.