The role of alcohol in the management of hypertension in patients in European primary health care practices - a survey in the largest European Union countries.
Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care.



Internet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed.



Overall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1-35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6-23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8-8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries.



While current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care.
Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada.|Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.|Faculty of Medicine, Medical Sciences Building, Institute of Medical Science, University of Toronto, Toronto, Canada.|Department of Psychiatry, University of Toronto, Toronto, Canada.|Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany.|WHO Collaborating Center for Mental Health and Addiction, Centre for Addiction and Mental Health, Toronto, Canada.
Jürgen
J
Rehm
Primary Health Care Center La Eria Oviedo, Oviedo, Spain.|Primary Care Spanish Society SEMERGEN, Madrid, Spain.
Jose Angel Arbesu
JA
Prieto
Bavarian GP association (BHÄV), Munich, Germany.
Markus
M
Beier
Société Française de Médecine Générale, Issy les Moulineaux, France.|DUMG SMBH Université Paris 13, Bobigny, France.|CMS Cornet, Pantin, France.
Didier
D
Duhot
Italian College of General Practitioners, Florence, Italy.
Alessandro
A
Rossi
Centre for Interdisciplinary Addiction Research, Hamburg University, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany.
Bernd
B
Schulte
Primary Health Care Center Ibiza, Servicio Madrileño de Salud, Madrid, Spain.|Sociedad Española de Medicina Familiar y Comunitaria (semFYC), Madrid, Spain.|Departamento Medicina Interna, Universidad Complutense de Madrid, Madrid, Spain.
José
J
Zarco
Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.|APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France.
Henri-Jean
HJ
Aubin
Copentown Healthcare Consultants, Cape Town, South Africa.
Michael
M
Bachmann
General Practitioner, Bradford, UK.|Royal College of General Practitioners, London, UK.
Carsten
C
Grimm
IFT Institut für Therapieforschung, Munich, Germany.|Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden.
Ludwig
L
Kraus
Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany. jakob.manthey@tu-dresden.de.|Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jakob.manthey@tu-dresden.de.
Jakob
0000-0003-1231-3760
J
Manthey
WHO Collaborating Center for Health Promotion and Research on Alcohol and Alcohol-related Health Problems, Rome, Italy.|Population Health Unit, National Observatory on Alcohol, CNESPS, Rome, Italy.|Società Italiana di Alcologia (SIA), Italian Society of Alcohology, Bologna, Italy.
Emanuele
E
Scafato
Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Barcelona, Spain.
Antoni
A
Gual
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005060:Europe; D005062:European Union; D005260:Female; D058006:General Practice / Q000193:education; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D020377:Self Efficacy
Alcohol use disorders; Blood pressure; Disease management; Hazardous drinking; Hypertension; Primary health care; Screening