The Pharmaceutical Journal
Vol 268 No 7188 p311-320
9 March 2002

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Doctors too unwilling to treat high BP

Doctors in primary care do not treat hypertension aggressively because they are willing to accept an elevated systolic blood pressure in their patients, say researchers from the United States.

Dr Susan Oliveria, Memorial Sloan-Kettering cancer centre, New York, and colleagues say: "Efforts to understand poor blood pressure control have usually focused on patient adherence with therapy." However, doctors working in primary care might not be aggressive enough in their management of the condition.

The researchers identified 314 patients with uncontrolled hypertension who visited their doctor during a three-week study period. They then asked the doctors about their willingness to increase the intensity of treatment.

The researchers found that drug therapy was initiated or changed in 38 per cent of patient-visits, despite documented hypertension for at least the previous six months. The most commonly given reason for not starting or changing therapy was that doctors were satisfied with blood pressure values.

Other reasons given were that the focus of the visit had not been blood pressure control or that there was a need to monitor patients before changing the drug regimen.

"Our findings seem to suggest that [doctors] are familiar with the guidelines for treating hypertension but do not implement this knowledge into their everyday practice. This has an important public health impact because of the positive association between systolic blood pressure and cardiovascular disease," the researchers conclude (Archives of Internal Medicine, 2002;162:413).