Major cardiovascular risk factors are not taken into account by physicians when targeting blood pressure values for uncontrolled hypertensive patients

Abstract

Background: The main factors studied possibly explaining inadequate blood pressure (BP) control in the population are related either to treatment or to patients. Subjective behavior of physicians might also explain insufficient BP control in the population. This study analyzed the consistency between systolic BP (SBP) targets set by physicians for uncontrolled hypertensive patients and the guidelines according to cardiovascular (CV) risk factors. Methods: A total of 993 general practitioners completed 2,455 questionnaires which included items related to the clinical and biological characteristics of uncontrolled hypertensive patients. At the end of each questionnaire, physicians noted the SBP level they targeted for each patient. The coronary heart disease (CHD) risk score was computed for each patient according to the Framingham study. Results: The mean SBP target set by physicians was 136 ± 6 mm Hg. However, in 24% of the patients, SBP targets set by physicians were higher than those recommended and, above all, the higher the Framingham CHD risk score, the lower the percentage of subjects with correctly targeted SBP goals. SBP values targeted by physicians were higher than recommended goals mostly in patients with diabetes and/or renal impairment. Interestingly, the targeted SBP was significantly and positively correlated with the previously determined office SBP (r = 0.26, P < 0.001). Conclusions: The higher the CV risk, the lower the number of patients with targeted SBP in accordance with guidelines. When considering CV risk factors, physicians did not take into account that a lower BP goal is advocated for patients with diabetes and renal impairment. © 2008 American Journal of Hypertension, Ltd.