Medical practitioners' views on the management of hypertension in Trinidad and Tobago.
ABSTRACT We surveyed 161 medical practitioners in Trinidad and Tobago (124 reporting private sector practice and 37 describing government health centre practice) for their views on blood pressure (BP) management. 96% of the respondents agreed that BP should be measured on all adults seen and 90% agreed that diastolic pressure should be recorded as the disappearance of sounds. There was disagreement over the level of diastolic BP at which drug treatment should be initiated: 63% would treat diastolic BP less than 100 mm Hg, but 35% would only treat diastolic BP of 110 mm Hg or higher. In private practice 31% preferred angiotensin converting enzyme (ACE) inhibitors as treatment for an African Caribbean man with diastolic BP 110 mm Hg, but in public clinics 41% preferred thiazide diuretics. ACE inhibitors were most often preferred as treatment for an Indo-Caribbean man with diabetes and diastolic BP 110 mm Hg in both public and private practice. Doctors considered that noncompliance (66%), lack of education (34%) and unhealthy lifestyles (25%) were important obstacles to BP control. In private practice doctors considered patients' financial constraints to be an obstacle (58%), whereas in the public sector limited availability of drugs (57%) was felt to be more important. Less costly and, possibly, more appropriate drugs were used in public clinics.