Hypertension is prevalent in the community1 and the most frequently managed problem in general practice.2 High blood pressure (BP) is a leading cause of mortality and disease burden.3 Globally, it has been difficult to attain optimal hypertension treatment and control rates.1,4,5 Therefore, both the initiation of antihypertensive medication and the intensification of treatment to therapeutic goals in those with hypertension have been identified as evidence practice gaps.6 Identifying the barriers that prevent the best use of evidence is an important first step in designing an intervention to close that evidence practice gap.
Elevated blood pressure (BP) is
a major modifiable risk factor.
However hypertension still remains
underdiagnosed, untreated or
suboptimally treated. This study
aimed to identify and explore barriers
to initiating medication and treating
elevated BP to target levels in the
general practice setting.
Six focus groups involving 30 clinicians
were audio recorded, transcribed in full
and analysed for common emerging
themes using an iterative thematic
After making the decision to commence
treatment, medication initiation was
relatively straightforward. Clinical
uncertainty about true underlying
BP, distrust of measurement
technology, and distrust of the
evidence underpinning hypertension
management were expressed. Patient
age, gender and comorbidity influenced
treatment strategy. Related themes
included perceived patient attitude,
clinical inertia, and patient centred
care. Systems issues included lack of
resources and lack of time.
The management of an asymptomatic
chronic disease within a patient centred,
encounter based primary care context
can be challenging.
Download the PDF for the full article.