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Impediments to the control of hypertension. Hypertension Management Audit Group
1World Hypertension League, Geneva, Switzerland.
Insights
Effective hypertension management remains a challenge, with many cases undetected or untreated. Physician workload and patient-perceived lack of interest contribute to suboptimal blood pressure control, highlighting a need for improved strategies.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Despite therapeutic advances, hypertension control in populations remains suboptimal, even in developed healthcare systems.
- Significant percentages of hypertension cases were undetected (18-34%) or untreated (22-38%) in European centers during the late 1980s.
Purpose of the Study:
- To assess impediments to better hypertension control through the World Health Organization/World Hypertension League (WHO/WHL) Hypertension Management Audit Project.
- To survey physician concepts and attitudes regarding hypertension management.
Main Methods:
- Survey of 2,215 physicians regarding their concepts and attitudes towards hypertension management.
- Inquiry into perceived reasons for delayed hypertension detection and treatment.
Main Results:
- A significant proportion of physicians (25-45%) were reluctant to initiate drug treatment below 100 mm Hg diastolic pressure.
- Physicians cited workload as a reason for delayed detection, while patients perceived a lack of physician interest in taking blood pressure readings.
- Overall patient satisfaction with hypertension care was suboptimal.
Conclusions:
- Barriers to effective hypertension control include physician attitudes towards treatment initiation and perceived reasons for delayed diagnosis.
- Suboptimal patient satisfaction and physician information sources suggest a need for improved hypertension management strategies and physician education.
Abstract:
Despite the great therapeutic advances, the control of hypertension in populations is far below the achievable level, even in populations with highly developed health care. By the end of the 1980's, in selected European centres, 18-34% of cases of hypertension were undetected, and among those previously known, 22-38% were untreated. The cooperative WHO/WHL Hypertension Management Audit Project aimed at assessing some of the impediments to better control of hypertension. The concepts and attitudes of 2,215 physicians were surveyed. In various centres and at various patient ages, 25-45% of physicians would not start drug treatment below 100 mm Hg. When inquiring into the perceived reasons why hypertension had not been detected earlier, among other reasons, physicians tended to incriminate their workload, while patients often felt that there was a lack of interest on the doctor's part to take a blood pressure reading. In general, patient satisfaction seemed suboptimal. Physician's sources of information were varied; neither WHO, nor ISH or WHL seemed to play an important role in informing the physicians.