Hypertension guidelines and their limitations – the impact of physicians’ compliance as evaluated by guideline awareness

Hagemeister, Jens; Schneider, Christian A.; Barabas, Sven; Schadt, Rüdiger; Wassmer, Gernot; Mager, G.; Pfaff, Holger; Höpp, Hans W.

doi:10.1097/00004872-200111000-00020

Cited by 99 publications

(85 citation statements)

References 18 publications

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“…Such information would have been necessary in order to ascertain significant differences regarding age and duration of clinical practice between respondents and nonrespondents. Despite these limitations, our findings are in substantial agreement with three recent studies carried-out, respectively, in USA, 26 Germany 15 and Belgium. 7 In a mail survey aimed at obtaining estimates of primary-care physicians' approaches to the treatment of hypertension, and investigating how JNC guidelines influence their decisions, Hyman and Pavlik demonstrated that 41% of the 316 respondent physicians had neither heard or were not familiar with the content of the national guidelines.…”

Section: Discussionsupporting

confidence: 92%

“…This cutoff represents a correct response rate to the questions 460% and has also been used as index of adequate of awareness in a recent large mailing survey. 15 As a sound management of hypertension cannot be achieved without a precise diagnosis of arterial hypertension, a correct answer to the question on the definition of hypertension according to guidelines (first question) had to be included among the six correct answers. In addition, demographic and clinical data were also analysed, and the impact of physician's age, gender and duration of clinical practice on the answers was assessed by univariate analysis.…”

Section: Analysis Of Datamentioning

confidence: 99%

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Awareness of hypertension guidelines in primary care: results of a regionwide survey in Italy

et al. 2003

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Unsatisfactory blood pressure (BP) control so often described in treated hypertensive populations is also explained by insufficient physicians' awareness of experts' guidelines. We assessed awareness of current recommendations about hypertension management in a general practice setting, using the World Health Organization/International Society of Hypertension (WHO/ ISH) 1999 guidelines as reference. In a regionwide survey, a total of 5133 physicians (three-quarters of all active general practitioners in Lombardy, a region of north-western Italy) were contacted by letter and received a multiple choice 10-item questionnaire. Data on physicians' demographic characteristics, information on hypertension prevalence and their perception of BP control among their patients were also requested in an additional form. The number of answers in agreement with WHO/ISH guidelines was used as an awareness measure. This was considered adequate if correct answers to six out of 10 questions, including an appropriate definition of hypertension, were provided. Of the 1256 returned questionnaires (a 24.5% response rate), 1162 were suitable for analysis. The mean score of correct answers was 5.3 points and only 20.1% of the study population correctly answered at least six of the questions (including that on the definition of hypertension in the elderly). Guidelines awareness was negatively related to increase in physicians' age and duration of clinical practice and by the male gender. Finally, the physicians reported a high rate of achieved BP control, and those who were considered to have achieved highest rates (475%) of control in their patients had a lower rate of adequate knowledge than those who reported less-successful therapeutic results (18 vs 25%, Po0.01), suggesting that they ignored or disregarded the goal BP recommended by the guidelines. This large regional survey shows that a sufficient degree of guidelines awareness is present in a minority of primary-care physicians in the Italian region of Lombardy. Therefore, further efforts are required to intensify information strategies for improving professional education, training and practice organization aimed at achieving therapeutic goals. Physicians with longer duration of clinical practice represent a particularly relevant target group for these interventions.

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Section: Discussionsupporting

confidence: 92%

Section: Analysis Of Datamentioning

confidence: 99%

Awareness of hypertension guidelines in primary care: results of a regionwide survey in Italy

et al. 2003

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“…Recently, a nationwide survey involving 11 547 German physicians showed that adequate awareness of guidelines of diagnosis, treatment, and control of hypertension did not exceed 25% of the survey participants. 7 The same pattern of poor hypertension control, which particularly affected the elderly, has been consistently found in other studies involving different populations or health-care systems. [8][9][10][11] It is probably related to vascular biology and stiffening of the arteries, and not to poor quality of care of older hypertensives.…”

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confidence: 70%

Determinants of poor hypertension management in the community

Maziak¹,

Keil²,

Döring³

et al. 2003

J Hum Hypertens

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“…3 Another study showed that sufficient knowledge of hypertension guidelines was found in only 37% of cardiologists and 19% of general practitioners. 17 In this study, over 60% of patients who did not achieve BP targets at any given follow-up visit had their antihypertensive medication unchanged. Physicians justify this high degree of therapeutic inertia with the assumption that the time for the drug to show the full effect is too short or that a clear improvement is acceptable.…”

Section: Discussionmentioning

confidence: 69%

“…This compares favourably with previous reports. 8,17 In the United States, many physicians have been reported to apply BP The number of patients at visit 3 is superior to that of visit 2 on account of the fact that some patients do not attend visit 2.…”

Section: Discussionmentioning

confidence: 99%

Reasons for therapeutic inertia when managing hypertension in clinical practice in non-Western countries

Ferrari

2008

J Hum Hypertens

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The main reasons for not intensifying antihypertensive treatment when BP remained above goal were the assumption that the time after starting the new drug was too short to attain its full effect, the satisfaction with a clear improvement of BP or with a BP nearing the goal, and the acceptance of good self-measurements. In this open intervention program in primary care, a large proportion of patients achieved recommended BP goals. The belief that a clear improvement in BP is acceptable and that the full drug effect may take up to several weeks to be reached are frequent reasons for treatment inertia when goals are not achieved.

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Hypertension guidelines and their limitations – the impact of physicians’ compliance as evaluated by guideline awareness

Abstract: The impact of hypertension guidelines on actual medical knowledge is modest. Thus, the information strategies about current treatment guidelines must be improved and tailored to the needs of physicians in clinical practice to ultimately improve patient care.

Cited by 99 publications

References 18 publications

Awareness of hypertension guidelines in primary care: results of a regionwide survey in Italy

Awareness of hypertension guidelines in primary care: results of a regionwide survey in Italy

Determinants of poor hypertension management in the community

Reasons for therapeutic inertia when managing hypertension in clinical practice in non-Western countries

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