title: The management of severe hypertension in Australian general practice.
abstract: BACKGROUND
  Severe hypertension (SHT) (Blood Pressure, BP ≥ 180/110 mmHg) is associated with considerable morbidity and mortality, yet little is known about how it is managed. The purpose of this study is to examine the management of SHT by Australian general practitioners (GPs) and to explore its variance across patient characteristics and clinical practices.
  
  
  METHODS
  Review of electronic medical records for a year before and after a recorded measure of SHT in 7,499 patients by 436 GPs in 167 clinics throughout Australia during 2008-2009. Outcome measures included follow-up, referral, changes to antihypertensive drug treatment, and BP control (normotensive reading, BP < 140/90 mmHg, and whether subsequent recorded measures were also in the normal range--sustained normotension).
  
  
  RESULTS
  Of 7,499 patients with an electronic BP record of SHT, 94% were followed up (median time 14 days); 8% were referred to an appropriate specialist (median time 89 days--2% within 7 days) and 86% were managed by GPs. GPs initiated or changed antihypertensive drugs in 5,398 patients (72% of cohort); of these, 46% remained hypertensive (4% with SHT) and 7% achieved sustained normotension; 6% had no further electronic BP records. The remaining 14% had no medication changes; among these, 43% remained hypertensive (5% with SHT) and 3% achieved sustained normotension; 32% had no further electronic BP records. Some outcome measures displayed a variance across GP clinics that was mostly unexplained by patient or practice characteristics.
  
  
  CONCLUSIONS
  Most patients with SHT had at least one follow-up visit and 72% had initiation of, or changes to, antihypertensive drug treatment. Although most of the patients experienced some improvement, blood pressure control was poor. Some clinics showed better performance. Suggestions are made for the development of clinical standards to facilitate appropriate management of this dangerous condition.
authors.affiliation: Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney 2052, Australia. b.gallego@unsw.edu.au.
authors.forename: Blanca
authors.initials: B
authors.lastname: Gallego
authors.forename: William B
authors.initials: WB
authors.lastname: Runciman
authors.forename: Oscar
authors.initials: O
authors.lastname: Perez-Concha
authors.forename: Siaw-Teng
authors.initials: ST
authors.lastname: Liaw
authors.forename: Ric O
authors.initials: RO
authors.lastname: Day
authors.forename: Adam G
authors.initials: AG
authors.lastname: Dunn
authors.forename: Enrico
authors.initials: E
authors.lastname: Coiera
mesh_terms: D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data
chemical_list: D000959:Antihypertensive Agents