General practitioners' approach to hypertension in urban Pakistan: disturbing trends in practice.
BACKGROUND
Control of blood pressure (BP) remains suboptimal worldwide. The objective of this study was to determine whether (primary) general practitioners' (GPs) approach to high BP is in accordance with international guidelines.


RESULTS
We conducted a cross-sectional survey of 1000 randomly selected GPs from urban areas in Pakistan during 2002. A rigorously developed questionnaire on (1) type of practice and (2) detection, (3) evaluation, (4) treatment, and (5) source of information about high BP was administered by trained medical personnel. A total of 1051 GPs were approached, and 1000 (95%) consented to enroll; 766 were male and 655 had been in practice > or =10 years. The average number of patients (SD) seen per day was 48.2 (42.7). Overall, 30.6% (29.0% to 32.3%) and 79.7% (78.3% to 81.0%) of GPs used incorrect BP cutoffs to diagnose hypertension in patients <60 and > or =60 years, respectively. Appropriate therapy for hypertension in the elderly was initiated by only 34.7% (33.0% to 36.3%) of GPs. The use of sedatives either alone (23.8%) or in combination with antihypertensive agents as first-line medication for lowering BP was reported by 45.0% (43.2% to 46.7%). Thiazide diuretics were rarely prescribed (4.2%). Sublingual antihypertensive agents were prescribed by 68.7% (67.1% to 70.3%) of GPs for treating very high levels of BP. The practices of recent graduates from medical school were not better than those of older graduates.


CONCLUSIONS
GPs in Pakistan underdiagnose and undertreat high BP, especially in the elderly. Our findings underscore the need for urgent revision of teaching curricula in medical schools with regard to the risks, complications, and management of hypertension, as well as the initiation of widespread and intensive continuing medical education for all physicians involved in the management of patients with hypertension. Particular efforts are needed to encourage the use of low-cost thiazide diuretics as antihypertensive agents in developing countries.
Jafar
Tazeen H
TH
Section of Nephrology, Department of Medicine, Aga Khan University, PO Box 3500, Stadium Road, Karachi, 74800, Pakistan. tazeen.jafar@aku.edu
Jessani
Saleem
S
Jafary
Fahim H
FH
Ishaq
Mohammad
M
Orakzai
Raza
R
Orkazai
Raza
R
Orakzai
Sarwar
S
Orkazai
Sarwar
S
Levey
Andrew S
AS
Chaturvedi
Nish
N
D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003625:Data Collection; D003906:Developing Countries; D004363:Drug Utilization; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010821:Physicians, Family / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D011287:Prejudice; D011795:Surveys and Questionnaires; D014505:Urban Population
D000959:Antihypertensive Agents