Poor blood pressure control in general practice: in search of explanations.
BACKGROUND
Arterial hypertension is managed mainly by general practitioners. The blood pressure level of most patients treated in a general practice setting is greater than or equal to 140/90 mmHg.


OBJECTIVE
To understand why a blood pressure level greater than or equal to 140/90 mmHg does not lead to a change of treatment.


METHODS
Over a 2-week period, 479 hypertensive patients were included in a cross-sectional study by 27 general practitioners. Consultation data were collected, as were reasons why patients with a blood pressure level greater than or equal to 140/90 mmHg did not have their treatment changed.


RESULTS
Blood pressure level was greater than or equal to 140/90 mmHg in 58% of patients; treatment was changed in 15% of these individuals. The lack of change in treatment was justified by the physicians as follows: the blood pressure measurements were not considered to be representative (about 30% of cases); the therapeutic result was considered to be satisfactory in the circumstances (about 30% of cases); change was not appropriate given the patient's specific context (the remaining third of cases). The proportion of uncontrolled hypertensive patients whose treatment remained the same was significantly higher among patients with a disease that affected their lifestyle or threatened their life expectancy.


CONCLUSIONS
The disappointing therapeutic results observed in the management of arterial hypertension do not arise only from poor application of guidelines by general practitioners. Reluctance to rely on blood pressure measurements, a perception that guidelines are revised frequently and are not always clear, and consideration of the general practitioner's activity in the patient's specific context are the main factors involved.
Nicodème
Robert
R
Département universitaire de médecine générale, faculté de médecine, CHU de Rangueil, 133, route de Narbonne, 31062 Toulouse cedex, France. dr.r.nicodeme@wanadoo.fr
Albessard
Artus
A
Amar
Jacques
J
Chamontin
Bernard
B
Lang
Thierry
T
D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D016896:Treatment Outcome
D000959:Antihypertensive Agents