DOCTORS ATTITUDES TOWARDS THE DETECTION AND TREATMENT OF HYPERTENSIONIN OLDER-PEOPLE

Within the former northern region a questionnaire was sent to a one in two random sample of general practitioners and to consultant physicia ns involved in the treatment of older hypertensive patients, to determ ine current attitudes of doctors to the management of hypertension in older people. A total of 407 general practitioners and 125 consultant physicians (including 38 consultant geriatricians) completed the quest ionnaire; response rates of 58% and 73% respectively, The median (rang e) threshold level for intervention of an otherwise well 75-year-old p atient was 180 (140-240)/100 (90-120) mm Hg for general practitioners as against current recommendations of greater than or equal to 160/90 mmHg, Geriatricians adopted significantly lower thresholds than both g eneral practitioners and other specialists, Target blood pressure (BP) and drug therapy were in line with British Hypertension Society recom mendations. The majority of general practitioners stated that they wou ld initiate treatment for hypertension later, be less aggressive in th eir treatment and accept higher levels of BP than with younger patient s, Approximately half perceived compliance and lifestyle changes as pr oblematic in older people, while approximately a third were concerned about the problems created by drug treatment and uncertainty about the practicality of treating all older hypertensive patients, A quarter e xpressed reluctance to initiate hypertensive treatment because of side effects and to treat isolated systolic hypertension. These stated att itudes amongst general practitioners may explain the continuing conser vatism in the management of hypertension, This study found considerabl e variation in diagnostic threshold between doctors, which suggests th at current management of hypertension in older people is likely to var y significantly.