Reported treatment of hypertension by family physicians in Sweden and Minnesota: a physician survey of practice habits.
OBJECTIVE
To compare family physicians' reported practice habits on hypertension in Sweden and Minnesota, and to assess to what extent different national guidelines account for differences.


METHODS
Random samples of family physicians were selected for telephone interviews on their practice of hypertension.


METHODS
Primary care in southern Sweden and in Minnesota.


METHODS
Family medicine specialists. Participation rates were 236/264 (89%) in Sweden and 183/209 (88%) in Minnesota.


METHODS
Cut-off levels, and non-pharmacological and pharmacological treatment of hypertension, related to three case scenarios: a 48-year-old man, a 65-year-old man and a 65-year-old woman.


RESULTS
Swedish physicians reported significantly higher levels of diastolic blood pressure than Minnesota physicians for the institution of treatment of hypertension for all case scenarios. In both countries, physicians adhered to the cut-off levels of their national guidelines in the case of the 48-year-old man. Minnesota physicians did not use age as a modifying factor for treatment cut-off levels, as did Swedish physicians. Swedish physicians emphasized alcohol, fat and stress reduction, and Minnesota physicians weight and salt reduction as non-pharmacological treatment. While Swedish physicians generally preferred beta-blockers, Minnesota physicians chose ACE inhibitors or calcium channel blockers as the first choice drug.


CONCLUSIONS
Swedish and US guidelines on hypertension were identical except for higher cut-off level for drug treatment in Sweden. Minnesota physicians reported cut-off levels close to national guidelines. For 65-year-old patients, Swedish physicians reported applying a higher cut-off level than indicated by guidelines. Swedish physicians also reported preferring less expensive drugs. As a consequence of the differing national guidelines and the identified physicians' practice habits in the two medical communities, it is likely that the segments of the populations treated and the drug costs differ substantially.
Troein
M
M
Department of Community Medicine, Lund University, Malmö, Sweden.
Arneson
T
T
Råstam
L
L
Pirie
P L
PL
Selander
S
S
Luepker
R V
RV
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003971:Diastole; D005194:Family Practice; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013548:Sweden
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers