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Open Access Highly Accessed Research article

Lack of adherence to hypertension treatment guidelines among GPs in southern Sweden-A case report-based survey

Rickard Ekesbo124*, Patrik Midlöv12, Sofia Gerward3, Kristin Persson1, Christina Nerbrand2 and Lennart Johansson2

Author Affiliations

1 General Practice/Family Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden

2 The R&D Department of Primary Care, Malmö, Region Skåne, Sweden

3 Cardiovascular Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden

4 Dalby Primary Health Care Centre, Skolgatan 1, S-240 10, Dalby, Sweden

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BMC Family Practice 2012, 13:34  doi:10.1186/1471-2296-13-34

Published: 26 April 2012

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.

Method

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.

Conclusion

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.

Keywords:
Hypertension; Adherence; Guidelines; Treatment; Primary care