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Delphi panel study of current hypertension treatment patterns
A Richter1, C Ostrowski, M P Dombeck
1Research Triangle Institute, Research Triangle Park, North Carolina 27709, USA. anke@rti.org
Insights
Physician practices for managing mild to moderate hypertension often differ from JNC-VI guidelines. This study used a Delphi panel to identify these differences for cost-effectiveness modeling.
Area of Science:
- Cardiology
- Internal Medicine
- Health Services Research
Background:
- Current clinical practice for managing mild to moderate hypertension may not align with established guidelines.
- The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) provides specific recommendations.
- Understanding practice variations is crucial for improving patient outcomes and healthcare efficiency.
Purpose of the Study:
- To compare usual physician practices in managing mild to moderate hypertension against JNC-VI recommendations.
- To gather data on physician consensus regarding hypertension definitions, treatment, and follow-up for a cost-effectiveness model.
Main Methods:
- A Delphi panel survey was administered to U.S. general practitioners and cardiologists.
- The survey focused on reaching consensus on JNC-VI guidelines for defining hypertension, treatment strategies, and patient follow-up.
- Ten physicians completed both rounds of the questionnaire.
Main Results:
- Significant variation exists in how physicians define blood pressure ranges, often citing higher limits than JNC-VI.
- Physicians adhered to JNC-VI guidelines approximately 60% of the time.
- Comorbidities and hypertension severity primarily influenced initial drug choice, with patient demographics being secondary. Follow-up protocols varied.
- Dose titration occurred 1-2 times before discontinuation for lack of efficacy, with routine follow-up every 3-4 months post-control.
Conclusions:
- Clinical practice patterns for hypertension management show notable divergence from JNC-VI guidelines.
- The study identified specific areas of discrepancy in practice, informing the development of a cost-effectiveness model.
- The findings provide essential data on management and prescribing patterns for hypertension models.
Objective:
The purpose of this study was to assess whether, and to what extent, usual practice in the management of patients with mild to moderate hypertension differs from that recommended in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI). The results were used as input for a clinical decision analytic model to assess the cost-effectiveness of a new treatment for hypertension.
Methods:
A Delphi panel survey of general practitioners and cardiologists in the United States was conducted to determine current strategies for the treatment of mild to moderate uncomplicated hypertension. The purpose of the panel survey was to reach consensus on 3 key facets of the JNC-VI guidelines and how they relate to the respondents' clinical practices: (1) the definition of mild to moderate hypertension, (2) the treatment that adult patients with uncomplicated mild to moderate hypertension should receive, and (3) the management of patient follow-up.
Results:
Of the 20 physicians contacted for the survey, 10 responded to both rounds of the questionnaire. There was considerable variation in the responses for defining the ranges of healthy, acceptable, unacceptable, and serious blood pressure. In general, the Delphi panel respondents cited higher limits than stated in the JNC-VI guidelines. Physicians followed the guidelines approximately 60% of the time. Primary determinants of initial drug choice among the panelists were comorbid conditions and the severity of hypertension; patients' age, race, and sex were secondary determinants. Follow-up typically occurred 1 month after therapy initiation. Panelists reported titrating the dose of new therapies upward once or twice before discontinuing the drug for lack of efficacy. Once adequate blood pressure control was achieved, patient follow-up was reported to occur every 3 to 4 months.
Conclusions:
This Delphi panel study highlights the differences between clinical practice and the JNC-VI guidelines in the treatment of hypertension. The results were used as a basis for defining a structure for a cost-effectiveness model and provided the management practice and prescribing practice patterns required by the model.
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