title: Managing hypertension in general practice: a cross-sectional study of treatment and ethnicity.
abstract: BACKGROUND
  NICE guidelines are the accepted standard for determining the management of hypertension in UK primary care.
  
  
  OBJECTIVE
  To explore adherence and non-adherence to NICE hypertension guidelines, the extent to which this influences blood pressure control,  and the role of ethnicity.
  
  
  METHODS
  A cross-sectional study was conducted based on primary care data from Lambeth DataNet, a database of primary care records in one inner-city London borough.
  
  
  METHODS
  NICE guidelines were used to determine adherence  to recommended treatment options for four groups of patients with hypertension: aged <55 years on monotherapy; aged ≥55 years on monotherapy; any age on dual therapy; any age and with comorbid diabetes. Blood pressure control was determined for each treatment category and ethnic group.  The study controlled for age, sex, social deprivation, and clustering within general practices.
  
  
  RESULTS
  A total of 32 183 patients were identified with a current diagnosis of hypertension. Ethnic coding was available for 28 320 (88.0%). Overall, 13 546 patients with ethnicity  coding could be allocated to one of the four clinical categories of hypertension; 44% of these patients received non-guideline-adherent treatment; ethnicity was not a significant determinant. Mean arterial pressure did not differ significantly between those receiving 'correct'  or 'incorrect' hypotensive therapy.
  
  
  CONCLUSIONS
  Evidence-based guidelines for the management of hypertension were not followed in a relatively large proportion of patients included in this study. Nevertheless, no evidence was found that failure to follow treatment  recommendations resulted in poorer blood pressure control. Further work is needed to determine the reasons for non-implementation of guideline recommendations in primary care.
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Schofield
authors.forename: Frances
authors.initials: F
authors.lastname: Baawuah
authors.forename: Paul T
authors.initials: PT
authors.lastname: Seed
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000502:physiology; D044383:Black People / Q000706:statistics & numerical data*; D017691:Caribbean Region / Q000208:ethnology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000208:ethnology; D004359:Drug Therapy, Combination; D005260:Female; D058006:General Practice / Q000379:methods / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents