Self-reported hypertension treatment beliefs and practices of primary care physicians in a managed care organization

Division of Clinical Epidemiology, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
American Journal of Hypertension (Impact Factor: 2.85). 04/2005; 18(4 Pt 1):566-71. DOI: 10.1016/j.amjhyper.2004.10.030
Source: PubMed


Blood pressure (BP) is controlled to recommended goal in less than one-third of people with hypertension. There has been little recent research on physician beliefs and practices with regard to the treatment of hypertension.
In late 1999, we surveyed 104 primary care physicians in the 18 owned clinics of a large staff model, non-profit health maintenance organization. The survey included questions about demographics, BP treatment goals for patients with uncomplicated hypertension, and beliefs about hypertension.
The reported systolic BP treatment goal was < or =140 mm Hg for 97% and the diastolic BP goal was < or =90 mm Hg for 100%. The systolic BP goal for patients with isolated systolic hypertension was < or =140 mm Hg for 82%, but 34% stated that they would treat to a different goal depending on the diastolic BP. The proportions of physicians who would intensify treatment for BP of 140/90 mm Hg, 150/95 mm Hg, 165/75 mm Hg, and 165/65 mm Hg were 64%, 97%, 89% and 77%, respectively. Although 93% believed that medication was necessary to control BP in most cases, a majority (55%) agreed with the statement that BP could be controlled in most patients with only one drug. Although 42% reported that they often had to change drugs because of side effects, only 16% believed that it was time-consuming to find a well-tolerated drug regimen.
In this setting, primary care physicians' self-reported practices were in good agreement with national guidelines put forth in the late 1990s, and their beliefs were favorable to therapy. Our data point to a need for interventions to emphasize that combination drug therapy is frequently required to achieve BP control, and that more aggressive intervention is often warranted for isolated systolic hypertension.

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    • "Uncertainty as to whether clinical BP reflects the true value of BP is one of the main reasons for not intensifying therapy in uncontrolled hypertensive patients, an issue that has been systematically examined in diabetics with HT [9]. Other studies have found that one reason physicians say they theoretically would not intensify treatment [10], [11], or actually do not intensify it in their own practice [10], [12], [13], is satisfaction with BP values close to the therapeutic goal. In reality, physicians usually overestimate the degree of BP control in their patients [14]–[16]. "
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    ABSTRACT: We examined physician perception of blood pressure control and treatment behavior in patients with previous cardiovascular disease and uncontrolled hypertension as defined by European Guidelines. A cross-sectional study was conducted in which 321 primary care physicians throughout Spain consecutively studied 1,614 patients aged ≥18 years who had been diagnosed and treated for hypertension (blood pressure ≥140/90 mmHg), and had suffered a documented cardiovascular event. The mean value of three blood pressure measurements taken using standardized procedures was used for statistical analysis. Mean blood pressure was 143.4/84.9 mmHg, and only 11.6% of these cardiovascular patients were controlled according to 2007 European Guidelines for Hypertension Management target of <130/80 mmHg. In 702 (49.2%) of the 1426 uncontrolled patients, antihypertensive medication was not changed, and in 480 (68.4%) of these cases this was due to the physicians judgment that blood pressure was adequately controlled. In 320 (66.7%) of the latter patients, blood pressure was 130-139/80-89 mmHg. Blood pressure level was the main factor associated (inversely) with no change in treatment due to physician perception of adequate control, irrespective of sociodemographic and clinical factors. Physicians do not change antihypertensive treatment in many uncontrolled cardiovascular patients because they considered it unnecessary, especially when the BP values are only slightly above the guideline target. It is possible that the guidelines may be correct, but there is also the possibility that the care by the physicians is appropriate since BP <130/80 mmHg is hard to achieve, and recent reviews suggest there is insufficient evidence to support such a low BP target.
    Full-text · Article · Sep 2011 · PLoS ONE

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    ABSTRACT: Despite the availability of effective therapy, hypertension remains poorly controlled and noncompliance has been identified as the predominant reason for failure of hypertension therapy. The aim of this study is to explore, (a) the patient¿s reports about their adherence and difficulties for the fulfillment of the treatment; (b) the relationship between information they had received about the consequences for health of hypertension and what they really believed about; (c) the patients¿ beliefs about the hypertension as a disease; and (d) the change in their way of living after the diagnosis. 171 hypertensive patients participated. Results shows that only 11,7% of patients reported not having problems to follow treatment, identifying as the main difficulties the adherence to diet and exercise; a high percentage of patients showed no correspondence between their beliefs about the consequences of hypertension and the information received in medical consultation; only 57% of the patients reported to have the idea of hypertension as a chronic disease; and 40,9% of the patients reported only some changes in their way of life after being diagnosed which might indicate failures in adherence at the beginning of the treatment. The importance of these results to improve adherence to treatment in hypertensive patients is discussed.
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