Self-reported prescribing for hypertension in general practice

OBJECTIVE: To describe the self-reported management of hypertension in general practice and how this compares to national guidelines for hypertension. DESIGN: Analysis of self-reported cross-sectional clinical audit data. SETTING: Australian general practice for the years 1999, 2001, 2003 and 2004. STUDY POPULATION: A total of 5247 general practitioners who voluntarily participated in one of four hypertension clinical audits and provided data for 105,086 adult patients with a previous diagnosis of hypertension. MAIN OUTCOME MEASURES: Selection of blood pressure targets consistent with recommendation of hypertension guidelines, percentage of patients achieving target blood pressure and percentage of patients with selected co-morbidities treated with the preferred class of antihypertensive medications. RESULTS: In 2001, target blood pressures of 140/90 mmHg and 130/85 mmHg were being used for 38% and 55% of patients, respectively. In 2004, target blood pressures were 140/90 mmHg (39%), 130/85 mmHg (49%) and 125/75 mmHg (0.5%). In 2003 and 2004, 58% and 70% of patients were reported to have achieved a target blood pressure that was consistent with guidelines according to patient age and co-morbidities. However, only 54-62% of hypertensive patients with heart failure were prescribed an ACE inhibitor and 52% of patients with a history of myocardial infarction were receiving a beta-blocker or ACE inhibitor. CONCLUSIONS: The self-reported data from general practitioners participating in clinical audits show that these general practitioners are using blood pressures targets consistent with guideline recommendations for most patients and that more patients are reaching their target blood pressure. However, drug selection based on co-morbidities could improve.