General practitioners ignore high normal blood pressure.
The objective of the study was to assess the ability of Polish primary care physicians to diagnose elevated blood pressure in cases with different cardiovascular risks. A questionnaire, containing eight written cases differing in relation to three major variables, was developed to conduct a survey in a stratified sample of primary health care physicians in Poland. The variables were: (i) levels of blood pressure (high normal (HN) or grade 2 hypertension (HT2); (ii) coexistence of selected risk factors (RF+/-) and (iii) diabetes mellitus (DM+/-). The response rate was 65% (125/192 selected physicians). The correct diagnosis of blood pressure (BP) level was confirmed in 54.8% of answers. The percentages of incorrectly diagnosed cases with HN BP were, respectively, 64.0% (RF-, DM-), 77.6% (RF+, DM-), 80.0% (RF+, DM+) and 84.0% (RF-, DM+). In the cases with HT2, the incorrect diagnosis ranged from 8.8% (RF+, DM-) to 20.8% (RF-, DM-). In subgroup analysis of four cases with different levels of BP, the appearance of DM significantly increased the levels of incorrect diagnosis of cases with HN BP (p<0.001). Older physicians would make an incorrect diagnosis significantly more often (r = 0.38, p<0.001). Most primary care physicians would ignore HN BP, even in diabetic patients. The age of the physician is a significant factor contributing to incorrect diagnosis.
Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland. mmwindak@cyf-kr.edu.pl
Adam
A
Windak
Barbara
B
Gryglewska
Tomasz
T
Tomasik
Krzysztof
K
Narkiewicz
Tomasz
T
Grodzicki
D000367:Age Factors; D001291:Attitude of Health Personnel; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D011044:Poland; D011320:Primary Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires