title: Physician perception of blood pressure control and treatment behavior in high-risk hypertensive patients: a cross-sectional study.
abstract: OBJECTIVE
  We examined physician perception of blood pressure control and treatment behavior in patients with previous cardiovascular disease and uncontrolled hypertension as defined by European Guidelines.
  
  
  METHODS
  A cross-sectional study was conducted in which 321 primary care physicians throughout Spain consecutively studied 1,614 patients aged ≥18 years who had been diagnosed and treated for hypertension (blood pressure ≥140/90 mmHg), and had suffered a documented cardiovascular event. The mean value of three blood pressure measurements taken using standardized procedures was used for statistical analysis.
  
  
  RESULTS
  Mean blood pressure was 143.4/84.9 mmHg, and only 11.6% of these cardiovascular patients were controlled according to 2007 European Guidelines for Hypertension Management target of <130/80 mmHg. In 702 (49.2%) of the 1426 uncontrolled patients, antihypertensive medication was not changed, and in 480 (68.4%) of these cases this was due to the physicians judgment that blood pressure was adequately controlled. In 320 (66.7%) of the latter patients, blood pressure was 130-139/80-89 mmHg. Blood pressure level was the main factor associated (inversely) with no change in treatment due to physician perception of adequate control, irrespective of sociodemographic and clinical factors.
  
  
  CONCLUSIONS
  Physicians do not change antihypertensive treatment in many uncontrolled cardiovascular patients because they considered it unnecessary, especially when the BP values are only slightly above the guideline target. It is possible that the guidelines may be correct, but there is also the possibility that the care by the physicians is appropriate since BP <130/80 mmHg is hard to achieve, and recent reviews suggest there is insufficient evidence to support such a low BP target.
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain. joseramon.banegas@uam.es
authors.forename: José R
authors.initials: JR
authors.lastname: Banegas
authors.forename: Krista
authors.initials: K
authors.lastname: Lundelin
authors.forename: Mariano
authors.initials: M
authors.lastname: de la Figuera
authors.forename: Juan J
authors.initials: JJ
authors.lastname: de la Cruz
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Graciani
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
authors.forename: Juan García
authors.initials: JG
authors.lastname: Puig
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D000959:Antihypertensive Agents