[Application of French guidelines in newly diagnosed hypertensive patients managed by general practitioners].

UNLABELLED

The French guidelines of the 2000 ANAES indicate that the management of patients with hypertension should not be based only on the level of blood pressure, but also on the presence of other risk factors and/or concomitant diseases such as diabetes or target organ damage.

OBJECTIVES

To evaluate if the 2000 ANAES Guidelines concerning the initiation of antihypertensive treatment are applied by general practitioners.

METHODS

Seventy new diagnosed hypertensive subjects, never treated by antihypertensive drugs, managed by 13 general practitioners were included in the study. From the data of the general practitioners medical report, the cardiovascular risk have been retrospectively recalculated for all the subjects. The concordance between the Guidelines and the clinical practice in term of institution of treatment have been evaluated.

RESULTS

In this population of mean age 58 +/- 15 years, a concordance of 64% between the 2000 ANAES Guidelines and the clinical practice was observed (45/70 subjects). Among the discordant subjects (36%, [25/70]), the treatment was instituted by excess in 88% of cases (22/25) although it was not recommended. In contrast, in the remaining 12% of cases, only lifestyle measures have been proposed although an antihypertensive treatment was recommended. The discordance concerns essentially subjects with medium cardiovascular risk (84%). The principal determinants of this discordance were the grade 2 of hypertension and the presence of few risk factors (1 or 2), where the cardiovascular risk have been overestimated.

CONCLUSIONS

Guidelines concerning the initiation of antihypertensive treatment in new diagnosed hypertensive subjects are more often applied by general practitioners. It is particularly in subjects with medium cardiovascular risk that the decision of the initiation of treatment is taken by excess in comparison to guidelines.