REPORTED TREATMENT OF HYPERTENSION BY FAMILY PHYSICIANS IN SWEDEN ANDMINNESOTA - A PHYSICIAN SURVEY OF PRACTICE HABITS

Objectives. To compare family physicians' reported practice habits on hypertension in Sweden and Minnesota, and to assess to what extent dif ferent national guidelines account for differences. Design, Random sam ples of family physicians were selected for telephone interviews on th eir practice of hypertension. Setting, Primary care in southern Sweden and in Minnesota. Subjects, Family medicine specialists. Participatio n rates were 236/264 (89%) in Sweden and 183/209 (88%) in Minnesota. M ain outcome measures. Cut-off levels, and non-pharmacological and phar macological treatment of hypertension, related to three case scenarios : a 48-year-old man, a 65-year-old man and a 65-year-old woman, Result s, Swedish physicians reported significantly higher levels of diastoli c blood pressure than Minnesota physicians for the institution of trea tment of hypertension for all case scenarios. In both countries, physi cians adhered to the cut-off levels of their national guidelines in th e case of the 48-year-old man. Minnesota physicians did not use age as a modifying factor for treatment cut-off levels, as did Swedish physi cians. Swedish physicians emphasized alcohol, fat and stress reduction , and Minnesota physicians weight and salt reduction as non-pharmacolo gical treatment. While Swedish physicians generally preferred beta-blo ckers, Minnesota physicians chose ACE inhibitors or calcium channel bl ockers as the first choice drug. Conclusion, Swedish and US guidelines on hypertension were identical except for higher cut-off level for dr ug treatment in Sweden. Minnesota physicians reported cut-off levels c lose to national guidelines. For 65-year-old patients, Swedish physici ans reported applying a higher cut-off level than indicated by guideli nes. Swedish physicians also reported preferring less expensive drugs, As a consequence of the differing national guidelines and the identif ied physicians' practice habits in the two medical communities, it is likely that the segments of the populations treated and the drug costs differ substantially.