Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians

Abstract

1. The attitudes of general practitioners and hospital physicians to the management of hypertension in the elderly, were examined by responses to a postal questionnaire distributed within the Northern Region, concerning the management of a healthy 75 year old male non-smoker with sustained diastolic or isolated systolic hypertension. 2. Two hundred and fourteen (64%) general practitioners and 127 (70%) hospital physicians responded to the questionnaire. General practitioners stated they would most commonly measure to the nearest 2 mm Hg (47%) as compared with nearest 5 mm Hg (61%) by physicians; P < 0.05. When measuring diastolic blood pressure 16% general practitioners and 31% physicians would use phase IV sounds; P < 0.01. 3. Median levels of hypertension, confirmed by repeated readings, at which antihypertensive therapy would be commenced were similar: 180 (150-230)/100(90-120) mm Hg vs 180 (150-200)/100 (90-120) mm Hg; median (range). The stated use of non-pharmacological methods to lower blood pressure before starting drug therapy was similar (74% vs 63%). General practitioners were more likely to prescribe a thiazide diuretic (70% vs 54%) and less likely to prescribe a calcium channel blocker (14% vs 28%) as first line therapy; data for diastolic hypertension, P < 0.001. 4. Considerable variation exists amongst both general practitioners and physicians in their stated assessment and management of a healthy elderly non-smoking male with sustained hypertension. General practitioners and physicians have similar stated thresholds for treating hypertension but differ in their choice of first line therapy. (ABTRACT TRUNCATED AT 250 WORDS)