The management of severe hypertension in Australian general practice

Blanca Gallego, William B. Runciman, Oscar Perez-Concha, Siaw Teng Liaw, Ric O. Day, Adam G. Dunn, Enrico Coiera

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Severe hypertension (SHT) (Blood Pressure, BP ≥ 180/110 mmHg) is associated with considerable morbidity and mortality, yet little is known about how it is managed. The purpose of this study is to examine the management of SHT by Australian general practitioners (GPs) and to explore its variance across patient characteristics and clinical practices. Methods. Review of electronic medical records for a year before and after a recorded measure of SHT in 7,499 patients by 436 GPs in 167 clinics throughout Australia during 2008-2009. Outcome measures included follow-up, referral, changes to antihypertensive drug treatment, and BP control (normotensive reading, BP < 140/90 mmHg, and whether subsequent recorded measures were also in the normal range - sustained normotension). Results: Of 7,499 patients with an electronic BP record of SHT, 94% were followed up (median time 14 days); 8% were referred to an appropriate specialist (median time 89 days - 2% within 7 days) and 86% were managed by GPs. GPs initiated or changed antihypertensive drugs in 5,398 patients (72% of cohort); of these, 46% remained hypertensive (4% with SHT) and 7% achieved sustained normotension; 6% had no further electronic BP records. The remaining 14% had no medication changes; among these, 43% remained hypertensive (5% with SHT) and 3% achieved sustained normotension; 32% had no further electronic BP records. Some outcome measures displayed a variance across GP clinics that was mostly unexplained by patient or practice characteristics. Conclusions: Most patients with SHT had at least one follow-up visit and 72% had initiation of, or changes to, antihypertensive drug treatment. Although most of the patients experienced some improvement, blood pressure control was poor. Some clinics showed better performance. Suggestions are made for the development of clinical standards to facilitate appropriate management of this dangerous condition.

LanguageEnglish
Article number414
JournalBMC Health Services Research
Volume13
Issue number1
DOIs
Publication statusPublished - 16 Oct 2013

Keywords

  • Chronic disease management
  • Electronic general practice records
  • Severe hypertension

ASJC Scopus subject areas

  • Health Policy

Cite this

Gallego, B., Runciman, W. B., Perez-Concha, O., Liaw, S. T., Day, R. O., Dunn, A. G., & Coiera, E. (2013). The management of severe hypertension in Australian general practice. BMC Health Services Research, 13(1), [414]. https://doi.org/10.1186/1472-6963-13-414
Gallego, Blanca ; Runciman, William B. ; Perez-Concha, Oscar ; Liaw, Siaw Teng ; Day, Ric O. ; Dunn, Adam G. ; Coiera, Enrico. / The management of severe hypertension in Australian general practice. In: BMC Health Services Research. 2013 ; Vol. 13, No. 1.
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Gallego, B, Runciman, WB, Perez-Concha, O, Liaw, ST, Day, RO, Dunn, AG & Coiera, E 2013, 'The management of severe hypertension in Australian general practice', BMC Health Services Research, vol. 13, no. 1, 414. https://doi.org/10.1186/1472-6963-13-414

The management of severe hypertension in Australian general practice. / Gallego, Blanca; Runciman, William B.; Perez-Concha, Oscar; Liaw, Siaw Teng; Day, Ric O.; Dunn, Adam G.; Coiera, Enrico.

In: BMC Health Services Research, Vol. 13, No. 1, 414, 16.10.2013.

Research output: Contribution to journalArticle

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AB - Background: Severe hypertension (SHT) (Blood Pressure, BP ≥ 180/110 mmHg) is associated with considerable morbidity and mortality, yet little is known about how it is managed. The purpose of this study is to examine the management of SHT by Australian general practitioners (GPs) and to explore its variance across patient characteristics and clinical practices. Methods. Review of electronic medical records for a year before and after a recorded measure of SHT in 7,499 patients by 436 GPs in 167 clinics throughout Australia during 2008-2009. Outcome measures included follow-up, referral, changes to antihypertensive drug treatment, and BP control (normotensive reading, BP < 140/90 mmHg, and whether subsequent recorded measures were also in the normal range - sustained normotension). Results: Of 7,499 patients with an electronic BP record of SHT, 94% were followed up (median time 14 days); 8% were referred to an appropriate specialist (median time 89 days - 2% within 7 days) and 86% were managed by GPs. GPs initiated or changed antihypertensive drugs in 5,398 patients (72% of cohort); of these, 46% remained hypertensive (4% with SHT) and 7% achieved sustained normotension; 6% had no further electronic BP records. The remaining 14% had no medication changes; among these, 43% remained hypertensive (5% with SHT) and 3% achieved sustained normotension; 32% had no further electronic BP records. Some outcome measures displayed a variance across GP clinics that was mostly unexplained by patient or practice characteristics. Conclusions: Most patients with SHT had at least one follow-up visit and 72% had initiation of, or changes to, antihypertensive drug treatment. Although most of the patients experienced some improvement, blood pressure control was poor. Some clinics showed better performance. Suggestions are made for the development of clinical standards to facilitate appropriate management of this dangerous condition.

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