Many Doctors Don't Know Blood Pressure Guidelines

FRIDAY Sept. 19, 2008 -- Too many family doctors don't start treatment of middle-aged men with high blood pressure when they should, a new study indicates.

The men in the study happened to be black, but the same is probably true for men in general, said Dr. Joseph Ravenell, who was expected to report the findings Friday at the American Heart Association's Council for High Blood Pressure Research annual meeting, in Atlanta.

Traditionally, most of the emphasis has been on patient behavior, such as noncompliance with medication and access to care, said Ravenell, who did the study while at the University of Texas Southwestern Medical Center at Dallas; he is now an assistant professor of medicine at New York University. But there is increasing evidence that the problem of poor hypertension control is not just about patients.

Ravenell and his Texas colleagues interviewed 891 black men in Dallas County, most of them being treated by primary-care physicians. The researchers also interviewed 22 community doctors, asking whether they would start drug treatment for a 45-year-old black man with an office blood pressure of 145/92 and an out-of-office pressure of 154/95, both well above the recommended 120/80 level.

Only 36 percent of the doctors said they would start treatment, Ravenell reported. And none of the 22 said they were familiar with the national guidelines calling for treatment of blood pressure at such levels.

The results are somewhat surprising but are consistent with other results in the literature which suggest that the guidelines aren't adhered to by physicians nearly as well as the guideline creators would like, Ravenell said.

How different the results might have been if the men were not black is uncertain, he said. Evidence does not suggest that blacks suffer more from poor guideline adherence by physicians, but that is still an open question, Ravenell said. It would be an interesting study to see if the same scenario with white men produced the same results, he added.

There is a lesson in the study for doctors, he said. The particular lesson is that physicians need to take a very good look at their own practices to make sure they are appropriately applying the guidelines to all patients, but particularly to black men, who are at high risk of death from hypertension, Ravenell said.

One lesson for people who are seen by the doctors is that people need to be aware of the guidelines, said Dr. Daniel Jones, vice chancellor for health affairs at the University of Mississippi, and a past president of the American Heart Association.

Another lesson is that they should know their blood pressure numbers and should speak up if the readings indicate high blood pressure, he said. Patients can influence doctors' choices by initiating discussions, Jones said.

National health surveys show that Americans are becoming more aware of the dangers of high blood pressure, a major risk factor for heart attack and stroke, and that it can be controlled by drug therapy, Jones said.

Posted: September 2008


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