MANAGEMENT OF HYPERTENSION AND THE CORE SERVICES GUIDELINES - RESULTSFROM INTERVIEWS WITH 100 AUCKLAND GENERAL-PRACTITIONERS

Aim. To determine if the management of a hypothetical case of essentia l hypertension by general practitioners conforms with the Report to th e National Advisory Committee on Core Health and Disability Services g uidelines on the Management of Raised Blood Pressure in New Zealand (C ore Services Report on Hypertension) sent to all general practitioners in November 1992. Method. A cross-sectional survey of a random sample of 100 Auckland general practitioners using a standard case of a 60 y ear old man with essential. hypertension. Seventy interviews were cond ucted by a face-to face interview and 30 by telephone interview. The m ain outcome measures were. Initial choice of medication and levels at which blood pressure would require treatment. Results. Forty one perce nt of the interviewed doctors had read the Core Services report on hyp ertension, Fifty percent of the doctors indicated they would use the r ecommended first line antihypertensive medication (ie, diuretic or bet a blocker). Doctors who prescribed beta blockers had been graduated a significantly longer time than those who did not. The majority of doct ors indicated that they would initiate pharmacological treatment at lo wer blood pressures in younger patients than older patients contrary t o the recommendation of the report. Conclusions. Current reported prac tice is only partially consistent with that suggested by the Core Serv ices report on hypertension, Approximately half of the doctors intervi ewed were prescribing the recommended first line medication, Treatment was more likely to be initiated at lower levels in younger patients t han in older patients in spite of the higher absolute risk and potenti al absolute benefit in the latter group. Adherence to the guidelines c ould see a shift from overtreatment of younger patients to an increase in treatment for older patients who are at higher risk of blood press ure related disease. More specific graduate educational measures will be needed if the Core Services report on hypertension are to be implem ented.