Blood pressure control in treated hypertensive patients: clinical performance of general practitioners

Background: The blood pressure of many neared hypertensive patients remains above recommended target levels. This discrepancy may be related to genera l practitioners' (GPs') actions. Aim: To assess clinical performance of GPs in blood pressure control in tre ated hypertensive patients and to explore the influence of patient and GP c haracteristics on clinical performance. Design of study: Cross-sectional study conducted on 195 GPs with invitation s to participate made via bulletins and by letter. Setting: One hundred and thirty-two practices in the southern half of The N etherlands from November 1996 to April 1997. Method Performance criteria were selected from Dutch national hypertension guidelines for general practice. GPs completed self-report forms immediatel y after follow-up visits of hypertensive patients treated with antihyperten sive medication. Results: The GPs recorded 3526 follow-up visits. In 63% of these consultati ons the diastolic blood pressure (DBP) was 90 mmHg or above. The median per formance rates of the GPs were less than 51% for most of the recommended ac tions, even at a DBP of greater than or equal to 100 mmHg. Performance of n on-pharmacological actions increased gradually with increasing DBP; prescri bing an increase in antihypertensive medication and making a follow-up appo intment scheduled within six weeks rose steeply at a DBP of greater than or equal to 100 mmHg. Patient and GP characteristics contributed little to cl inical performance. Action performance rates varied considerably between GP s. Conclusion: GPs seem to target their actions at a DBP of below 100 mmHg, wh ereas guidelines recommend targeting at a DBP of below 90 mmHg.