Audit of blood pressure control in a specialized hypertension clinic

The objective of the study was to estimate the control of elevated blood pr essure (BP) among patients regularly followed-up and to analyse physicians attitudes in patients having uncontrolled BP. Two hundred and fifty-eight consecutive patients (mean age 56 years, 58% of males) with essential hypertension attending the outpatient department of a specialised hypertension clinic, having at least a 6-month follow-up at t he clinic and at least 3 prior visits, were included in the study. Twelve d ifferent physicians were in charge of these patients. Data were collected [ 1] from the structured computerised record called ARTEMIS and [2] from a st ructured questionnaire filled up by the physician after each visit, where h e/she explained the reasons for his/her decisions. BP was measured by a nur se using an automatic device (oscillometric method) and then by a physician using a mercury sphygmomanometer. During follow-up, mean physician's BP fell from 179/107 to 148/91 mmHg and mean nurse BP fell from 164/96 to 143/83 mmHg. Percentages of patients havi ng a controlled hypertension (BP < 140/90 mmHg) were 27% (physician's BP) a nd 45% (nurse BP). Physicians did not modify treatment in 59% of patients a mong whom they measured a BP greater than or equal to 140/90 mmHg. The 3 ma in reasons given by physicians for not modifying treatment were: BP control led when using other BP measurement methods (nurse, home or ambulatory BP), 44%; BP control considered as satisfactory, 29%; systolic hypertension in the elderly, 8%. The person (physician or nurse) who measures BP and the measurement method have dramatic consequences an BP control level. Reasons for not modifying t reatment in uncontrolled patients (physician's BP greater than or equal to 140/90 mmHg) were based on opinions rather than evidence, for example when isolated systolic hypertension in the elderly is concerned.