title: Lack of adherence to hypertension treatment guidelines among GPs in southern Sweden-a case report-based survey.
abstract: BACKGROUND
  General practitioners (GPs) often fail to correctly adhere to guidelines for the treatment of hypertension. The reasons for this are unclear, but could be related to lack of knowledge in assessing individual patients' cardiovascular disease risk. Our aim was to investigate how GPs in southern Sweden adhere to clinical guidelines for the treatment of hypertension when major cardiovascular risk factors are taken into consideration.
  
  
  METHODS
  A questionnaire with five genuine cases of hypertension with different cardiovascular risk profiles was sent to a random sample of GPs in southern Sweden (n=109) in order to investigate the attitude towards blood pressure (BP) treatment when major cardiovascular risk factors were present.
  
  
  RESULTS
  In general, GPs who responded tended to focus on the absolute target BP rather than assessing the entire cardiovascular risk factor profile. Thus, cases with the highest risk of cardiovascular disease were not treated accordingly. However, there was also a tendency to overtreat the lowest risk individuals. Furthermore, the BP levels for initiating pharmacological treatment varied widely (systolic BP 140-210 mmHg). ACE inhibitors (70%) were the most common first choice of pharmacological treatment.
  
  
  CONCLUSIONS
  In this study, GPs in Southern Sweden were suggesting, for different cases, either under- or overtreatment in relation to current guidelines for treatment of hypertension. On reason may be that they failed to correctly assess individual cardiovascular risk factor profiles.
authors.affiliation: General Practice/Family Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden. rickard.ekesbo@skane.se
authors.forename: Rickard
authors.initials: R
authors.lastname: Ekesbo
authors.forename: Patrik
authors.initials: P
authors.lastname: Midlöv
authors.forename: Sofia
authors.initials: S
authors.lastname: Gerward
authors.forename: Kristin
authors.initials: K
authors.lastname: Persson
authors.forename: Christina
authors.initials: C
authors.lastname: Nerbrand
authors.forename: Lennart
authors.initials: L
authors.lastname: Johansson
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000628:therapy; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013548:Sweden