HOW INFORMED GENERAL-PRACTITIONERS MANAGE MILD HYPERTENSION - A SURVEY OF READERS OF DRUG BULLETINS IN 7 COUNTRIES

Objective: To determine whether general practitioners (GP) who are rea ders of independent drug bulletins can be used as an international epi demiological observatory of the criteria adopted by ''well informed'' doctors in various countries in the management of mild hypertension. D esign: Questionnaire study of GPs' diagnostic criteria for mild hypert ension, routine investigation and management of patients with this dia gnosis. Participants: 206 GPs readers of independent drug bulletins in 7 countries, comprising 95 known systematic readers of a local bullet in and III randomly selected regular subscribers. Main outcome measure s: Response rate to the questionaire. Diagnostic criteria, routine inv estigations, and treatment used for patients with mild hypertension. R esults: The study required two months for planning and implementation, Four countries out of eleven had a response rate less than or equal t o 50% and were excluded; the frequency of responses from other countri es was 69%. The average diastolic blood pressure (DBP) considered diag nostic of mild hypertension range from 94 mm Hg (lower threshold) to 1 06 (upper threshold), A minority (17%) of GPs routinely request the mi nimum recommended laboratory tests to assess patients. GPs routinely a dvise non-drug measures before starting a drug. Most would not start d rug treatment in patients without other risk factors and a DBP below 1 00 mm Hg. The top first choice drugs were diuretics and beta-adrenocep tor blockers. Half of the doctors were able to quote some published gu ide to the management of mild hypertension, and 18% cited a relevant t rial. Attitudes in diagnosing and treating mild hypertension differed widely between CPs and countries. Conclusions: GP readers of drug bull etins can be used quickly and inexpensively to assess the extent to wh ich recommended diagnostic and therapeutic practices are accepted by ' 'well informed'' doctors. The results suggest that attitudes in managi ng mild hypertension vary widely among GPs and countries and differ re markably from the recommendations of published guidelines.