Individual variation between general practitioners in labelling of hypertension

Area of Science:

• Cardiology
• General Practice
• Public Health

Background:

• Hypertension diagnosis relies on consistent criteria for effective management.
• Opportunistic screening programs aim to identify and manage hypertension in primary care.
• Variability in diagnostic practices can impact patient care and population health outcomes.

Purpose of the Study:

• To investigate the variation in hypertension diagnosis among general practitioners (GPs).
• To assess adherence to established diagnostic criteria during opportunistic screening.
• To identify factors influencing GP decision-making in labeling patients as hypertensive.

Main Methods:

• A continuous opportunistic hypertension screening program was conducted in a single general practice.
• Twelve GPs participated, applying agreed-upon criteria (systolic ≥ 200 mmHg or diastolic ≥ 110 mmHg on three consecutive readings).
• Data collected included patient counts, blood pressure readings, and individual GP diagnostic patterns over five years.

Main Results:

• The number of patients labeled hypertensive increased from 505 to 801 over five years.
• Significant variation existed in the number of hypertensive patients identified by individual GPs, ranging from 8 to 112 initially and 4 to 46 during screening.
• Only 24% of patients met the full diagnostic criteria, indicating GPs used factors beyond measured blood pressure.

Conclusions:

• General practitioners exhibit substantial variability in diagnosing and labeling hypertension.
• Individual GP criteria and unmeasured factors significantly influence hypertension diagnosis.
• Standardization of diagnostic approaches is needed to ensure consistent hypertension management in primary care.