High blood pressure diagnosis and treatment: consensus recommendations vs actual practice.

Abstract

Diagnostic and treatment practices of institutional facilities treating high blood pressure in New York City were surveyed by mail in 1978. Respondents were adhering to the treatment recommendations of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. Ninety-two per cent of respondents reported 90-104 mm Hg as the diastolic blood pressure level at which drug therapy was initiated, indicating a more aggressive approach than was warranted by the information available at the time of the survey. (Am J Public Health 1981; 71:413-416.) In 1976, the New York Heart Association surveyed all facilities in New York City that provided detection and treatment services for hypertension. ' (Table 1).More than 80 per cent of the respondents included elevated systolic pressure and target organ damage as factors influencing the decision to initiate medication. A family history of the complications of hypertension was an influencing factor for 64 per cent of the respondents. Ninety per cent of general medical clinics replied that they considered the fam-*Of the 64 respondents, 38 (59 per cent) were hospitals, eight were industrial settings, five were Health Insurance Plan groups, 12 were free standing treatment and diagnostic centers, and one was a private ambulatory care facility. Twenty-three responses came from hypertension specialty clinics and 21 came from general medical clinics. The remainder were from group practice settings, free standing ambulatory services, or industrial services.

Mild Hypertension: The Question of Treatment

“…This judgment does not overlook the difficult questions that remain in completely answered (31,63,78,83). Under the auspices of the WHO and other organizations, discussions in the recent past have emphasized the world-wide concern with hypertension and its treatment and prevention (81,98).…”

Mild Hypertension: The Question of Treatment

“…This judgment does not overlook the difficult questions that remain in completely answered (31,63,78,83). The question of the safety of anti hypertensive drugs can be addressed more fu lly from the data collected in the completed trials, but the limited duration of follow-up and size of study popUlations may leave open the question of rare, serious adverse effects.…”

How much can blood pressure be lowered?

“…Physicians have been convinced of the necessity of measuring blood pressure and treating even mild asymptomatic hypertension, through the accelerated circulation of information to them from expert committees and university medical teachers and from the effort of pharmaceutical firms to inform them that control of high blood pressure is beneficial and feasible. In Great Britain 3 as in the United States, 4 most clinicians believe that they should treat mild hypertension, even at a blood pressure level for which the scientific evidence of the benefit of treatment is not available. The difference between the opinions of some British and American experts 22 '" is reflected in the opinions of the practitioners in each of these two countries.…”