Factors influencing the decision to start drug treatment in hypertension. A questionnaire study comparing general practitioners and hypertension specialists in Denmark

Objective. To determine the factors influencing treatment decisions in patients with hypertension. Methods. A postal questionnaire based on five constructed cases with hypertension was sent to 122 general practitioners (GPs) in the area around Herlev University Hospital and to 46 Danish hypertension specialists. The cases varied in gender, age, blood pressure, cholesterol, diabetes and smoking status and absolute risk for cardiovascular events. Results. Response rate was 46% for GPs and 59% for specialists. There were no significant differences in treatment decisions nor in drug choices for first-line monotherapy, which were diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor antagonists in both groups of physicians. Blood pressure alone was the most important factor for instituting drug therapy according to 59% of the GPs and 56% of the specialists. There was no association between pre-treatment risk assessment and instituting treatment in either group in four out of five cases. Conclusions. We found agreement with respect to all treatment decisions between GPs and hypertension specialists. The results from this study suggest that, in both GPs and specialists, a blood pressure threshold approach to treating hypertension is still dominating.