[Setting blood pressure targets in patients with uncontrolled hypertension: physicians' subjective criteria]

Of the factors so far studied that might explain insufficient blood pressure (BP) control, the principal characteristics involve the treatment (pharmacological activity, drug combinations and adverse effects) or the patient (compliance, tolerance). The original purpose of this observational study was to investigate factors that may influence the BP target set by physicians for patients with uncontrolled hypertension.

In this survey, 2024 general practitioners included 6031 patients with uncontrolled hypertension (BP>140/90 mmHg).

The mean age of the study population (44% women and 42% workers) was 60+/- 12 years. Mean BP values were 160.8+/-11.8 mmHg systolic and 93.3+/-8.4 mmHg diastolic. The systolic BP targets set by the physicians (mean: 136.5+/-5.6 mmHg) were in accordance with current guidelines. Nevertheless, the steps taken to achieve these goals were barely adequate. Our results suggest that physician-related barriers to achieving BP control are associated with use of a single drug for treatment and BP targets that rise with patients' BP and body mass index. As expected, diabetes mellitus and microalbuminuria prompted physicians to set lower BP targets. Conversely, contrary to guidelines, kidney failure was not taken into account in the therapeutic decision.

Improving the therapeutic management of hypertension and continuing to decrease its effects on cardiovascular and renal morbidity and mortality require better continuing education for healthcare professionals or the development of incentive plans or both.