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An emerging consensus among clinicians on treating mild hypertension but persistent uncertainty as to how blood
L S Wilkinson1, I J Perry, R A Shinton
1University Department of Medicine, Dudley Road Hospital, Birmingham.
Insights
A 1990 survey revealed that while most clinicians align with British Hypertension Society guidelines on drug therapy thresholds for high blood pressure, many still use non-standard methods for blood pressure measurement.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
- Hypertension Management
Background:
- The British Hypertension Society issued guidelines in 1986 and 1989 concerning blood pressure measurement techniques and treatment thresholds.
- Assessing the adoption of these guidelines into clinical practice is crucial for effective hypertension management.
Purpose of the Study:
- To evaluate the impact of the British Hypertension Society's 1986/1989 recommendations on the clinical practices of hospital-based clinicians.
- To compare current blood pressure measurement and treatment threshold practices with those reported in a 1979 survey.
Main Methods:
- A self-reported questionnaire survey was administered to 196 hospital-based clinicians in 1990.
- Data from 126 respondents (64% response rate) were analyzed and compared to a previous 1979 survey.
- Key areas assessed included diastolic blood pressure measurement phase, patient positioning, and blood pressure reading precision.
Main Results:
- Significant variation exists in blood pressure measurement techniques; 37% used the fourth Korotkoff phase, 52% the fifth, and 10% both.
- Disagreement was noted on patient positioning (sitting vs. lying) and measurement precision (2, 5, or 10 mmHg).
- A majority of clinicians (over 100 mmHg diastolic) indicated prescribing antihypertensive drugs, aligning with 1979 shifts and Society recommendations, despite inconsistent measurement practices.
Conclusions:
- While treatment thresholds for hypertension align with British Hypertension Society recommendations, adherence to standardized blood pressure measurement techniques remains suboptimal.
- Continued education and emphasis on guideline implementation are necessary to ensure accurate blood pressure assessment and management.
Abstract:
In 1986 and 1989 the British Hypertension Society published its recommendations on the techniques for the measurement of blood pressure and the level of pressure requiring drug therapy. In order to assess the impact of these recommendations on clinical practice among non-members of the society, we have conducted a survey using a self-reported questionnaire among 196 hospital-based clinicians, and compared our findings with a similar survey conducted in 1979. The response rate to the 1990 survey was 64% (126 respondents). Over one-third (37%) of respondents reported that they usually record the diastolic blood pressure at the fourth Korotkoff phase (muffling of sounds), 52% reported that they use the fifth phase (disappearance of sounds), and 10% reported that they record both the fourth and fifth phase. They also disagreed considerably on a number of other basic issues, including whether blood pressure should be routinely measured in the sitting or lying position, and whether readings should be taken to the nearest 2, 5 or 10 mmHg. A clear majority of clinicians indicated that they would prescribe antihypertensive drugs if the diastolic blood pressure was consistently over 100 mmHg. This represents a marked shift from the opinions expressed in 1979 and is in line with the British Hypertension Society's recommendations. However, many clinicians still measure blood pressure in a manner contrary to the society's guidelines.