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Blood pressure control in treated hypertensive patients: clinical performance of general practitioners
B D Frijling1, T H Spies, C M Lobo
1Centre for Quality of Care Research, University of Nijmegen, P O Box 9101, 6500 HB Nijmegen, The Netherlands. b.frijling@hsv.kun.nl
Insights
General practitioners (GPs) often fail to control blood pressure in hypertensive patients, frequently targeting below 100 mmHg instead of the recommended 90 mmHg. Patient and GP factors had minimal impact on this suboptimal clinical performance.
Area of Science:
- Cardiology
- General Practice
- Hypertension Management
Background:
- Many patients with treated hypertension exceed target blood pressure levels.
- This suggests a potential issue with general practitioners' (GPs') management strategies.
Purpose of the Study:
- To evaluate GPs' clinical performance in managing blood pressure for treated hypertensive patients.
- To investigate how patient and GP characteristics influence this clinical performance.
Main Methods:
- A cross-sectional study involving 195 GPs in the southern Netherlands (November 1996 - April 1997).
- Performance criteria were based on Dutch national hypertension guidelines.
- GPs completed self-report forms post-consultation with hypertensive patients on medication.
Main Results:
- Diastolic blood pressure (DBP) was ≥90 mmHg in 63% of 3526 recorded follow-up visits.
- Median GP performance for recommended actions was below 51%, even for DBP ≥100 mmHg.
- GP actions, such as increasing medication or scheduling follow-ups, increased significantly only at DBP ≥100 mmHg.
- Patient and GP characteristics had minimal influence on performance, which varied considerably among GPs.
Conclusions:
- GPs appear to aim for a DBP below 100 mmHg, deviating from the recommended target of below 90 mmHg.
- This suggests a need for improved adherence to hypertension guidelines in primary care settings.
Background:
The blood pressure of many treated hypertensive patients remains above recommended target levels. This discrepancy may be related to general practitioners' (GPs') actions.
Aim:
To assess clinical performance of GPs in blood pressure control in treated hypertensive patients and to explore the influence of patient and GP characteristics on clinical performance.
Design Of Study:
Cross-sectional study conducted on 195 GPs with invitations to participate made via bulletins and by letter.
Setting:
One hundred and thirty-two practices in the southern half of The Netherlands from November 1996 to April 1997.
Method:
Performance criteria were selected from Dutch national hypertension guidelines for general practice. GPs completed self-report forms immediately after follow-up visits of hypertensive patients treated with antihypertensive medication.
Results:
The GPs recorded 3526 follow-up visits. In 63% of these consultations the diastolic blood pressure (DBP) was 90 mmHg or above. The median performance rates of the GPs were less than 51% for most of the recommended actions, even at a DBP of > or = 100 mmHg. Performance of non-pharmacological actions increased gradually with increasing DBP; prescribing an increase in antihypertensive medication and making a follow-up appointment scheduled within six weeks rose steeply at a DBP of > or = 100 mmHg. Patient and GP characteristics contributed little to clinical performance. Action performance rates varied considerably between GPs.
Conclusion:
GPs seem to target their actions at a DBP of below 100 mmHg, whereas guidelines recommend targeting at a DBP of below 90 mmHg.