July 2010


Barriers to diagnosing and managing hypertension

A qualitative study in Australian general practice

Volume 39, No.7, July 2010 Pages 511-516

Faline Howes

Emily Hansen

Danielle Williams

Mark Nelson


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 analysis.


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.

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.

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