More consistency in cardiovascular prescribing in England is needed, according to Dr John Ferguson (medical director, Prescription Pricing Authority). There are "considerable" geographical variations in numbers of deaths from cardiovascular disease, which cannot be explained by factors relating to the local population, such as differences in smoking rates and blood pressure, he says.
Examining trends in prescribing for different classes of drugs, he says that there have been big changes over the past five years. The total use of diuretics remains constant but there has been an increase in prescribing of thiazide and loop diuretics and a reduction in that of other types. The use of beta-blockers has remained constant, with a threefold variation in their use between health authorities. There is a 2.4-fold variation by health authority in the use of ACE inhibitors, and national usage has increased by 250 per cent over the past five years. For calcium channel blockers, the variation between health authorities is threefold, with an increase of 50 per cent in national usage over the same period. Meanwhile, the prescribing of low dose aspirin has trebled, he said.
Prescribing of most lipid lowering agents is static or falling, with the exception of the statins which has increased nearly eightfold over the past five years. However, there is considerable variation in statin use between health authorities, with overall use of statins highest in the north west of England (British Journal of Cardiology 1999;6:459).