Objective: To determine whether general practitioners (GP) who are readers of independent drug bulletins can be used as an international epidemiological observatory of the criteria adopted by “well informed” doctors in various countries in the management of mild hypertension.
Design: Questionnaire study of GPs' diagnostic criteria for mild hypertension, routine investigation and management of patients with this diagnosis.
Participants: 206 GPs readers of independent drug bulletins in 7 countries, comprising 95 known systematic readers of a local bulletin and 111 randomly selected regular subscribers.
Main outcome measures: Response rate to the questionaire. Diagnostic criteria, routine investigations, and treatment used for patients with mild hypertension.
Results: The study required two months for planning and implementation. Four countries out of eleven had a response rate ≤50% and were excluded; the frequency of responses from other countries was 69%. The average diastolic blood pressure (DBP) considered diagnostic of mild hypertension range from 94 mm Hg (lower threshold) to 106 (upper threshold). A minority (17%) of GPs routinely request the minimum recommended laboratory tests to assess patients. GPs routinely advise non-drug measures before starting a drug. Most would not start drug treatment in patients without other risk factors and a DBP below 100 mmHg. The top first choice drugs were diuretics and β-adrenoceptor blockers. Half of the doctors were able to quote some published guide to the management of mild hypertension, and 18% cited a relevant trial. Attitudes in diagnosing and treating mild hypertension differed widely between GPs and countries.
Conclusions: GP readers of drug bulletins can be used quickly and inexpensively to assess the extent to which recommended diagnostic and therapeutic practices are accepted by “well informed” doctors. The results suggest that attitudes in managing mild hypertension vary widely among GPs and countries and differ remarkably from the recommendations of published guidelines.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Bircher J, Bogaert M, Dukes MNG, Eichelbaum M, Gram LF, Huller H, Orme M, Sjoqvist F, Tognoni G (1988) Clinical pharmacology in Europe: An indispensable part of the health service. Eur J Clin Pharmacol 33:535–539
Tognoni G, Alli C, Avanzini F, Bettelli G, Colombo F, Corso R, Marchioli R, Zussino A (1991) Radomized clinical trials in general practice: lessons from a failure. Bri Med J 303:969–971
Herxheimer A (1991) Strategies for improving drug safety in Europe: can general practitioners contribute? In: Kochen MM (ed) Rational pharmacotherpay in practice. Springer, Berlin pp 3–6
Editorial (1993) Drug promotion: stealth, wealth, and safety. Lancet 341:1507–1508
Grant GB, Gregory DA, van Zwanenberg TD (1985) Development of a limited formulary for general practice. Lancet I:1030–1032
Cialdella P, Figon G, Haugh MC, Boissel JP (1991) Prescription intentions in relation to therapeutic information: a study of 117 french general practitioners. Soc Sci Med 33:1263–1274
Finer D, Tomson G, eds (1992): Essential drug information. The story of a Workshop. Karolinska Institutet, Stockholm
Garattini S, Tognoni G (1993) Drug utilization reviews and pharmacoeconomics. Interaction after parallel development? Pharm Econ 4:162–172
Herxheimer A (1987) Basic information that prescribers are not getting about drugs. Lancet I:31–32
Herxheimer A (1991) Drug bulletins are part of the scientific literature. Curr Cont Life Sci 34:4–9
Guidelines Sub-Committee (1989) 1989 Guidelines for the management of mild hypertension: memorandum from a WHO/ISH Meeting. J Hypertens 7:689–693
Hodes C, Rogers PA, Everitt MG (1975) High blood pressure: detection and treatment by General Practitioners. Bri Med J 2:674–677
Cloher TP, Admin M, Whelton PK (1986) Physician approach to the recognition and initial management of hypertension. Arch Intern Med 146:529–533
WHO Drug Utilization Research Group (DURG) (1986) Therapeutic traditions in Northern Ireland, Norway and Sweden: II. Hypertension. Eur J Clin Pharmacol 30:521–525
Bucknall CA, Morris GK, Mitchell JRA (1986) Physicians' attitudes to four common problems: hypertension, atrial fibrillation, transient ischaemic attacks, and angina pectoris. Bri Med J 293:739–742
Waller PC, Mclnnes GT, Reid JL (1990) Policies for managing hypertensive patients: a survey of the opinions of British specialists. J Hum Hypertens 4:509–515
Weiland SK, Keil U, Spelsberg A, Hense KW, Hartel U, Gefeller O, Dieckmann W (1991) Diagnosis and management of hypertension by physicians in the Federal Republic of Germany. J Hypertens 9:131–134
Steven ID, Wilson DH, Wakefield MA, Beilby J, Coffey GA, Esterman AJ, Golding AP, Graham NMH, Litt JCB, Rohrsheim RA (1992) South Australian hypertension survey. General practitioner knowledge and reported management practice — a cause for concern? Med J Austr 156:423–428
Steven ID, Wilson DH, Wakefield MA, Beilby J, Coffey GA, Esterman AJ, Golding AP, Graham NMH, Litt JCB, Rohrsheim RA (1992) South Australian hypertension survey. General practitioner experiences with drug treatment. Med J Austr 156:641–644
Anonymous (1989) Diagnosis and management of hypertension — 1987. A nationwide survey of physicians' knowledge, attitudes and reported behaviour. US Department of Human Sciences. National Institutes of Health
Alli C, Avanzini F, Caimi V, Colombo F, Parma E, Passerini G, Tognoni G (1993) General practitioners' approach to the detection and treatment of hypertension. A survey in Lombardy, a region of northern Italy. High Blood Press Cardiovasc Prevent 2:283–290
MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R, Godwin J, Dyer A, Stamler J (1990) Blood pressure, stroke, and coronary disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335:765–674
Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, Godwin J, Qizilbash N, Taylor JO, Hennekens CH (1990) Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 335:827–838
Montanaro N, Magrini N, Vaccheri A, Battilana M (1992) Drug utilization in general practice: prescribing habits of National Formulary drugs by GPs of Emilia Romagna (Italy) in 1988 and 1989. Eur J Clin Pharmacol 42:401–408
The organisers in the participating countries were: M. Bogaert, Folia Pharmacotherapeutica (Belgium) · B. Vrhovac, Pharmaca and Bilten O Lijekovima (Croatia) · D. Broclain, La revue Prescrire (France) · P. K. Sarkar, Drug Disease Doctor (India) · P. Hardjasaputra, Farmakon; B. Santoso, S. S. Danu, Lembran Obat dan Pengobatan (Indonesia) · M. Miselli, G. F. Nasi, Informazioni sui Farmaci; D. Coen, Ricerca e Pratica; L. Bozzini, Dialogo sui Farmaci (Italy) · P. K. M. Lunde (Norway) D. Lee, Medicamentos y Terapeutica (Panama) · J. M. Recalde, Boletin terapeutico Andaluz (Spain) · T. N. C. Aturaliya, Drug Information Bulletin (Sri Lanka) · A. Herxheimer, Drug and Therapeutics Bulletin (United Kingdom)
About this article
Cite this article
Avanzini, F., Tognoni, G., Colombo, F. et al. How informed general practitioners manage mild hypertension: a survey of readers of drug bulletins in 7 countries. Eur J Clin Pharmacol 49, 445–450 (1996). https://doi.org/10.1007/BF00195929
- general practice
- disease management
- international differences