Physicians' knowledge, attitudes, and practice of pharmacologic treatment of hypertension

OBJECTIVE: To explore how well physicians who treat hypertension know the i ndications and contraindications for particular antihypertensive therapies, and how closely their opinions and practice of hypertension treatment agre e with national guidelines. METHODS: We surveyed by mail a stratified random sample of 10 000 US cardio logists, internists, and general/family practitioners. This survey explored their knowledge, attitudes, and practices with respect to the treatment of hypertension. Responses were compared with national guidelines and product labeling at the time of the survey. Results were stratified by physician s pecialty. RESULTS: A total of 1023 physicians, or 10.2% of the sample, responded to t he survey. Only 37.3% answered all four knowledge questions correctly, incl uding 25.7% of general/family practitioners, 38.3% of internists, and 49.5% of cardiologists (p < 0.001). In their attitudes with respect to evaluatin g high blood pressure and establishing treatment goals, most respondents ag reed with established guidelines. However, when asked how they would treat uncomplicated, mild hypertension, only 23% limited their selection to diure tics and <beta>-blockers in accordance with the guidelines. Cardiologists i n particular were more likely than internists or general/family practitione rs to choose other drug classes, such as angiotensin-converting enzyme inhi bitors or calcium-channel blockers. CONCLUSIONS: The results of our survey suggest that national efforts to edu cate physicians about the increasingly complex armamentarium for hypertensi on, and to persuade them to base their prescribing on the results of random ized, controlled trials of primary prevention, must be continued.