Doctors’ estimation of cardiovascular risk and willingness to give drug treatment in hypertension: fair risk assessment but defensive treatment policy

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ObjectiveWe studied the differences between recommendations given in the 1999 World Health Organization–International Society of Hypertension (WHO/ISH) Guidelines and doctors’ risk estimation and willingness to give antihypertensive drugs.MethodsA population-based sample, the WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (WHO MONICA) (n = 5997), was classified according to the 1999 WHO/ISH Hypertension Guidelines risk stratification scheme. A total of 54 subjects were randomly drawn from the 12 different risk categories. Written case stories were constructed based on risk-factor levels for each selected subject.Setting and participantsDoctors (n = 139), comprising general practitioners (GPs, n = 110) and specialists in internal medicine or cardiology (specialists, n = 29), in northern Sweden assessed 12 cases each.Main outcome measuresFactors used in risk assessment, estimation of cardiovascular risk, and willingness to give antihypertensive drugs.ResultsIn a multivariate logistic regression model including all doctors, most major risk factors were significantly associated with a higher estimated risk and willingness to give drug treatment. Estimated risk was lower than the risk classified by 1999 WHO/ISH Hypertension Guidelines, and there was no difference between GPs and specialists in this respect. The use of antihypertensive drugs was much lower than advocated by the guidelines, but specialists were more inclined to give antihypertensive drug treatment than GPs.ConclusionsDoctors estimated the cardiovascular risk as being less severe than the recommendation given in the 1999 WHO/ISH Hypertension Guidelines. Moreover, their willingness to prescribe antihypertensive drugs was also lower than that advocated by the guidelines. The control of hypertension is poor in the community today, and this seems to be the way the profession wants to have it.

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