Management of raised blood pressure in New Zealand: a discussion document.

Jackson, Rod; Barham, Paul; Bills, Janne; Birch, Torrey Boland; McLennan, Laura; MacMahon, Stephen; Maling, T. J. B.

doi:10.1136/bmj.307.6896.107

Cited by 210 publications

(106 citation statements)

References 11 publications

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“…In a recent study examining the views of hospital staff on the management of hypertension the median level of blood pressure at which consultants would initiate therapy in an asymptomatic 50 year old man was 95 mm Hg (range 85-115) suggesting that doctors may have a higher threshold for initiating therapy in older individuals with hypertension [14]. If decisions to treat hypertension are based on absolute cardiovascular risk, blood pressure lowering therapy should be initiated at a lower level in older individuals with hypertension [19]. In this study we did not seek to determine whether the respondents would initiate therapy at a lower level of blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Ford

Asghar

1995

Brit J Clinical Pharma

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1 The attitudes of general practitioners and hospital physicians to the management of hypertension in the elderly, were examined by responses to a postal questionnaire distributed within the Northern Region, concerning the management of a healthy 75 year old male non-smoker with sustained diastolic or isolated systolic hypertension. 2 Two hundred and fourteen (64%) general practitioners and 127 (70%) hospital physicians responded to the questionnaire. General practitioners stated they would most commonly measure to the nearest 2 mm Hg (47%) as compared with nearest 5 mm Hg (61%) by physicians; P < 0.05. When measuring diastolic blood pressure 16% general practitioners and 31% physicians would use phase IV sounds; P < 0.01. 3 Median levels of hypertension, confirmed by repeated readings, at which antihypertensive therapy would be commenced were similar: 180 (150-230)/100(90-120) mm Hg vs 180 (150-200)/100 (90-120) mm Hg; median (range). The stated use of non-pharmacological methods to lower blood pressure before starting drug therapy was similar (74% vs 63%). General practitioners were more likely to prescribe a thiazide diuretic (70% vs 54%) and less likely to prescribe a calcium channel blocker (14% vs 28%) as first line therapy; data for diastolic hypertension, P < 0.001. 4 Considerable variation exists amongst both general practitioners and physicians in their stated assessment and management of a healthy elderly non-smoking male with sustained hypertension. General practitioners and physicians have similar stated thresholds for treating hypertension but differ in their choice of first line therapy. These results suggest that effective interventions in addition to guidelines need to be developed if hypertension in the elderly is to be consistently managed.

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Section: Discussionmentioning

confidence: 99%

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Ford

Asghar

1995

Brit J Clinical Pharma

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“…1 The Framingham risk equations remain the most widely used for this purpose. 2 For example, most UK guidelines recommend antihypertensive treatment for those whose blood pressures exceed 140/90 mm Hg if their 10-year cardiovascular risk is 420%.…”

Section: Introductionmentioning

confidence: 99%

The effect of blood pressure and cholesterol variability on the precision of Framingham cardiovascular risk estimation: a simulation study

Marshall

2010

J Hum Hypertens

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This simulation study investigates the effects of withinindividual variability in estimated cardiovascular risk on categorization of patients as high risk. Published estimates of within-individual blood pressure and cholesterol variability were used to generate blood pressure and cholesterol levels for hypothetical subjects at a range of ages. These were used to calculate the estimated cardiovascular risk of each individual. The relationship between an individual's mean cardiovascular risk and within-individual coefficient of variation for cardiovascular risk was determined. Using the derived relationship, mean cardiovascular risk and withinindividual variation in risk was calculated for 5018 adults from a population health survey. From this, was determined their probability of being classified as high risk (420% 10-year cardiovascular risk) and the test characteristics of risk estimation at a range of ages. Within-individual variability in cardiovascular risk and potential for misclassification are both greater in lowerrisk populations. At age 35-44 years, the positive predictive value of a diagnosis of high risk is 0.61 (95% confidence interval (CI): 0.59-0.64), and at age 65-74 years, it is 0.94 (95% CI: 0.91-0.96). About 39% of adults under 45 years diagnosed as high risk are not at high risk. Cardiovascular risk assessment should be targeted at high-risk populations.

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“…4,[18][19][20][21] Despite the guidelines, GPs disagreed on whether the hypothetical patient should be treated, with almost half not wishing to treat. This negative attitude of some GPs towards treating the elderly hypertensive, previously noted also by others, 22,23 is clearly not due to ignorance of the true absolute benefits of treating hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Recently it has been suggested that GPs should make a multi-factorial assessment of all risk factors before commencing treatment, 25 a view supported by the New Zealand guidelines. 19 However, in the elderly the presence of a systolic pressure at or over 160 mm hg, or a diastolic pressure at or over 90 mm hg, indicates a substantial and potentially reversible risk of cardiovascular events, even in the absence of other risk factors. 5,26,27 Therefore, treating the elderly on the basis of hypertension alone, irrespective of other risk factors, is still appropriate.…”

Section: Discussionmentioning

confidence: 99%

Hypertension in the elderly: attitudes of British patients and general practitioners

1998

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The perceptions of patients and GPs of the risk of stroke in treated and untreated elderly hypertensives, and their attitudes towards anti-hypertensive therapy were examined. To explore attitudes of patients to the management of hypertension a qualitative approach was used, employing semi-structured interviews, with subsequent thematic analysis of the transcriptions. A questionnaire study of GPs' attitudes to the same subject was also conducted.The elderly (n ‫؍‬ 75) greatly overestimate the risks of hypertension and the benefits of treatment. Most would accept anti-hypertensive therapy despite being informed of the true risks, citing confidence in their doctor

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Management of raised blood pressure in New Zealand: a discussion document.

Cited by 210 publications

References 11 publications

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

The effect of blood pressure and cholesterol variability on the precision of Framingham cardiovascular risk estimation: a simulation study

Hypertension in the elderly: attitudes of British patients and general practitioners

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