General practitioners' knowledge of and attitudes to the management of hypertension in elderly patients.

BACKGROUND: It is not known whether the results from randomized controlled trials influence general practitioners' knowledge of and attitudes to clinical practice. AIM: This study set out to assess general practitioners' knowledge of and attitudes to the management of hypertension in patients aged 65 years and over after the publication of three randomized controlled trials.
METHOD: A cross-sectional survey of principals in general practice was undertaken using a self-administrated questionnaire. The study was confined to 35 randomly selected general practices whose patient catchment area lay within the boundary of Northamptonshire Family Health Services Authority. A total of 92 general practitioners from 27 practices responded. The main outcome measures were: the reported use of a protocol to manage elderly patients with hypertension; method and frequency of blood pressure measurement; influence of patients' age on diagnosing and initiating treatment of hypertension; and use of non-pharmacological and pharmacological therapies.
RESULTS: Eighty four per cent of the general practitioners reported starting treatment only after measuring blood pressure on three separate occasions; 99% measured blood pressure with the patient seated while 29% also measured blood pressure while the patient was standing. Half of the respondents reported treating patients with isolated systolic hypertension once systolic blood pressure exceeded 179 mmHg. All the general practitioners reported recommending non-pharmacological treatment prior to drug therapy; 83% would use a diuretic as their drug of first choice.
CONCLUSION: It appears that despite the publication of several sets of guidelines for the management of hypertension in elderly people, based on randomized controlled trials, there is still considerable variation in the knowledge and attitudes of general practitioners. However, compared with a previous survey in Leicestershire in 1991, the general practitioners in this study reported a lower blood pressure threshold for initiating treatment of elevated blood pressure in elderly patients, including those with isolated systolic hypertension, which may in part be attributed to the introduction of the guidelines.