Lack of adherence to hypertension treatment guidelines among GPs in southern Sweden-A case report-based survey

A questionnaire with five genuine cases of hypertension with different cardiovascular risk profiles was sent to a random sample of GPs in southern Sweden (n？=？109) in order to investigate the attitude towards blood pressure (BP) treatment when major cardiovascular risk factors were present.In general, GPs who responded tended to focus on the absolute target BP rather than assessing the entire cardiovascular risk factor profile. Thus, cases with the highest risk of cardiovascular disease were not treated accordingly. However, there was also a tendency to overtreat the lowest risk individuals. Furthermore, the BP levels for initiating pharmacological treatment varied widely (systolic BP 140-210？mmHg). ACE inhibitors (70%) were the most common first choice of pharmacological treatment.In this study, GPs in Southern Sweden were suggesting, for different cases, either under- or overtreatment in relation to current guidelines for treatment of hypertension. On reason may be that they failed to correctly assess individual cardiovascular risk factor profiles.High blood pressure (BP) is an important risk factor for cardiovascular disease [1]. In accordance with official guidelines [2], the overall cardiovascular risk should be taken into account before pharmacological treatment of high BP begins. There are a number of risk factors for developing manifest cardiovascular disease, most important of which are age, family history, gender, smoking, diabetes, hypercholesterolemia, low physical activity and low consumption of fruit and vegetables [3].In spite of clear guidelines on the treatment of high BP and the availability of a number of tools for risk assessment, there is large variation in the way that different GPs initiate treatment for high BP. Furthermore, a large proportion of patients with high BP receive no or inadequate treatment [4].In a previous study from our group, only 20% of patients treated from hypertension in primary care in southern Sweden reached the currentl