Delphi panel study of current hypertension treatment patterns

Objective: The purpose of this study was to assess whether, and to what ext ent, usual practice in the management of patients with mild to moderate hyp ertension differs from that recommended in the Sixth Report of the Joint Na tional Committee on Prevention, Detection, Evaluation, and Treatment of Hig h Blood Pressure (JNC-VI). The results were used as input for a clinical de cision analytic model to assess the cost-effectiveness of a new treatment f or hypertension. Methods: A Delphi panel survey of general practitioners and cardiologists i n the United States was conducted to determine current strategies for the t reatment of mild to moderate uncomplicated hypertension. The purpose of the panel survey was to reach consensus on 3 key facets of the JNC-VI guidelin es and how they relate to the respondents' clinical practices: (1) the defi nition of mild to moderate hypertension, (2) the treatment that adult patie nts with uncomplicated mild to moderate hypertension should receive, and (3 ) the management of patient follow-up. Results: Of the 20 physicians contacted for the survey, 10 responded to bot h rounds of the questionnaire. There was considerable variation in the resp onses for defining the ranges of healthy, acceptable, unacceptable, and ser ious blood pressure. In general, the Delphi panel respondents cited higher limits than stated in the JNC-VI guidelines. Physicians followed the guidel ines similar to 60% of the time. Primary determinants of initial drug choic e among the panelists were comorbid conditions and the severity of hyperten sion; patients' age, race, and sex were secondary determinants. Follow-up t ypically occurred 1 month after therapy initiation. Panelists reported titr ating the dose of new therapies upward once or twice before discontinuing t he drug for lack of efficacy. Once adequate blood pressure control was achi eved, patient follow-up was reported to occur every 3 to 4 months. Conclusions: This Delphi panel study highlights the differences between cli nical practice and the JNC-VI guidelines in the treatment of hypertension. The results were used as a basis for defining a structure for a cost-effect iveness model and provided the management practice and prescribing practice patterns required by the model.