Key result
Guideline use by general practitioners varied widely (25% to 90%), but there was no difference in hypertension treatment decisions for frail oldest-old patients between guideline users and non-users.
Why the study?
The best management of hypertension in frail oldest-old patients remains unclear, and specific guideline recommendations are lacking.
Does self-reported guideline use by general practitioners influence hypertension treatment decisions in frail oldest-old patients?
Cross-Sectional (n=2,543)
Yes
Does self-reported guideline use by general practitioners influence hypertension treatment decisions in frail oldest-old patients?
Self-reported guideline use by general practitioners does not alter hypertension treatment decisions for frail oldest-old patients, suggesting a need for more specific recommendations in this demographic.
Guideline use may not standardize hypertension care for frail oldest-old; leaves open targeted recommendations and prospective studies.
BACKGROUND: The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old. DESIGN/SETTING: Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey. METHODS: GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries. RESULTS: Overall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used. CONCLUSION: Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.
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Roulet et al. (2020) conducted a cross-sectional in Hypertension management in frail oldest-old patients (n=2,543). Guideline use vs. Non-use of guidelines was evaluated on Hypertension treatment decisions. Guideline use by general practitioners varied widely (25% to 90%), but there was no difference in hypertension treatment decisions for frail oldest-old patients between guideline users and non-users.
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