Open Access Highly Accessed Research article

The management of severe hypertension in Australian general practice

Blanca Gallego1*, William B Runciman2, Oscar Perez-Concha1, Siaw-Teng Liaw3, Ric O Day4, Adam G Dunn1 and Enrico Coiera1

Author Affiliations

1 Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney 2052, Australia

2 School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide SA 5000, Australia

3 School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia

4 St Vincent’s Clinical School, University of New South Wales, St Vincent’s Hospital, Darlinghurst NSW 2010, Australia

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BMC Health Services Research 2013, 13:414  doi:10.1186/1472-6963-13-414

Published: 14 October 2013

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.

Keywords:
Severe hypertension; Electronic general practice records; Chronic disease management