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Many Physicians Don't Treat BP of 140/90

Kate Traynor

At least one in four primary care physicians do not treat high blood pressure with drugs until it escalates well beyond currently recommended intervention levels, according to a survey of self-reported treatment practices.

The study (PDF), published in the Aug. 14 Archives of Internal Medicine, found that 43 percent of primary care physicians who treat hypertension would wait for a patient's systolic blood pressure (SBP) to exceed 160 mm Hg before prescribing an antihypertensive drug. Thirty-three percent would start drug treatment if the diastolic blood pressure (DBP) exceeded 95 mm Hg. 

Since 1988, the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC) has recommended using antihypertensive drugs to treat patients with an SBP over 139 mm Hg or a DBP greater than 89 mm Hg. 

Forty-one percent of the responding physicians admitted that they did not know about or were unfamiliar with JNC guidelines for treating hypertension. 

According to the study, conducted in 1996, 25 percent of the physicians would not intensify drug therapy to control a persistent DBP of 94 mm Hg if the patient has uncomplicated hypertension. Thirty-three percent would not intensify treatment for a persistent SBP of 158 mm Hg. 

Treatment of elderly patients was reportedly even less aggressive. Faced with a patient older than 70, 48 percent of the physicians reported that they would take no action to treat a DBP of 94 mm Hg, and 67 percent would not treat an SBP of 158 mm Hg. 

For initial drug therapy, most of the physicians indicated they prescribed an angiotensin-converting-enzyme (ACE) inhibitor over the diuretics and beta-blockers recommended by JNC. Black patients, though, were preferentially prescribed diuretics and calcium-channel blockers before ACE inhibitors. 

The researchers, from the Baylor College of Medicine in Houston, surveyed 1,200 physicians who described their specialty as internal medicine, family practice, or general practice. Physicians were randomly chosen from the American Medical Association master file. Thirty-four percent responded to the mail survey. 

To achieve better control of hypertension, the researchers wrote, primary care physicians must change their practices to reflect current guidelines. 

The most recent set of JNC guidelines (PDF) was published in 1997. 

ASHP Supports Better BP Control 

Earlier this year, ASHP called for routine and aggressive efforts to improve the control of blood pressure in patients with hypertension. The "ASHP Therapeutic Position Statement on Optimizing Treatment of Hypertension" reviews the sixth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure and urges pharmacists to join interdisciplinary approaches to improving treatment.