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Physician Approach to the Recognition and Initial Management of Hypertension: Results of a Statewide Survey of Maryland Physicians

Physician Approach to the Recognition and Initial Management of Hypertension: Results of a... Abstract • A representative sample of Maryland physicians in three practice settings (family/general, internal medicine, and specialty practice) participated in a survey designed to identify their attitudes toward patients with high blood pressure. Respondents recommended initial laboratory investigations more frequently and treatment at lower levels of blood pressure than was the case in a national physician survey performed in 1977. Family/general practitioners were the most cautious in respect to recommending antihypertensive drug therapy. They expressed greater enthusiasm, however, for nonpharmacologic treatment of hypertension and other cardiovascular risk factors. Physicians in each of the three practice settings expressed strong support for the use of diuretics as initial drug therapy in patients with mild hypertension. Impediments to long-term care were overwhelmingly believed to be patient-rather than physician-related. (Arch Intern Med 1986;146:529-533) References 1. Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: A cooperative study. JAMA 1977;237: 255-261.Crossref 2. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1980;140:1280-1285.Crossref 3. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1984;144:1045-1057.Crossref 4. Diagnosis and Management of Hypertension: A Nationwide Survey of Physicians' Knowledge, Attitudes, and Reported Behavior . US Dept of Health, Education, and Welfare publication (NIH) 79-1056, 1979. 5. Whelton PK: Mild hypertension: Is it important? South Med J 1981;74: 979-983.Crossref 6. Weinstein MC, Stason WB: Hypertension: A Policy Perspective . Cambridge, Mass, Harvard University Press, 1976, pp 51-62. 7. Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program. JAMA 1979;242:2562-2577.Crossref 8. Relman AS: Mild hypertension: No more benign neglect. N Engl J Med 1980;302:293-294.Crossref 9. Moser M: On the management of 'mild hypertension.' Arch Intern Med 1981;141:1587-1588.Crossref 10. The pressure to treat, editorial. Lancet 1980;1:1283-1284. 11. Madhaven S, Alderman MH: The potential effect of blood pressure reduction on cardiovascular disease: A cautionary note. Arch Intern Med 1981;141:1583-1588.Crossref 12. Oliver MF: Risks of correcting the risks of coronary disease and stroke with drugs. N Engl J Med 1982;306:297-298.Crossref 13. Kaplan NM: Whom to treat: The dilemma of mild hypertension. Am Heart J 1982;101:867-870.Crossref 14. Freis ED: Should mild hypertension be treated? N Engl J Med 1982; 307:306-309.Crossref 15. Enlund H, Nissinen A, Tuomilemto J: Antihypertensive drug treatment in a middle-aged population. Hypertension 1982;4:716-724.Crossref 16. Whelton PK: Systemic hypertension, diuretics, arrhythmias and death. Am J Cardiol 1985;55:221-222.Crossref 17. Kaplan N: New approaches to the therapy of mild hypertension. Am J Cardiol 1983;51:621-627.Crossref 18. Dollery CT: Management of hypertension: Risk-benefit ratio. J Hypertension 1984;2( (suppl) ):9-12. 19. Soltero I, Tsong Y, Cooper R, et al: A survey of patterns of nonpharmacologic care for hypertensive patients, including recommendations for their children. Hypertension 1980;2:215-220.Crossref 20. Thompson GE, Alderman MH, Wassertheil-Smoller S, et al: High blood pressure diagnosis and treatment: Consensus recommendations vs actual practice. Am J Public Health 1981;71:413-415.Crossref 21. Apostolides AY, Cutter G, Draus JF, et al: Impact of hypertension information on high blood pressure control between 1973 and 1978. Hypertension 1980;2:708-713.Crossref 22. Freeman DH, D'Atri DA, Hellenbrand K, et al: The prevalence distribution of hypertension: Connecticut adults 1978-1979. J Chronic Dis 1983;36:171-181.Crossref 23. Entwisle G, Scott JC, Apostolides AY, et al: A survey of blood pressure in the state of Maryland. Prev Med 1983;12:695-708.Crossref 24. Bone LE, Levine DM, Parry RE, et al: Update on the factors associated with high blood pressure compliance. Md State Med J 1984;33: 201-204. 25. Heller RF, Rose G: Current management of hypertension in hospital. Br Med J 1977;1:1441-1442.Crossref 26. Heller RF, Rose G: Current management of hypertension in general practice. Br Med J 1977;1:1442-1444.Crossref 27. Ritchie LD, Currie AM: Blood pressure recording by general practitioners in northeast Scotland. Br Med J 1983;286:107-109.Crossref 28. Coope J: Hypertension in general practice: What is to be done? Br Med J 1984;288:87-88.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Physician Approach to the Recognition and Initial Management of Hypertension: Results of a Statewide Survey of Maryland Physicians

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References (29)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360150147018
Publisher site
See Article on Publisher Site

Abstract

Abstract • A representative sample of Maryland physicians in three practice settings (family/general, internal medicine, and specialty practice) participated in a survey designed to identify their attitudes toward patients with high blood pressure. Respondents recommended initial laboratory investigations more frequently and treatment at lower levels of blood pressure than was the case in a national physician survey performed in 1977. Family/general practitioners were the most cautious in respect to recommending antihypertensive drug therapy. They expressed greater enthusiasm, however, for nonpharmacologic treatment of hypertension and other cardiovascular risk factors. Physicians in each of the three practice settings expressed strong support for the use of diuretics as initial drug therapy in patients with mild hypertension. Impediments to long-term care were overwhelmingly believed to be patient-rather than physician-related. (Arch Intern Med 1986;146:529-533) References 1. Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: A cooperative study. JAMA 1977;237: 255-261.Crossref 2. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1980;140:1280-1285.Crossref 3. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1984;144:1045-1057.Crossref 4. Diagnosis and Management of Hypertension: A Nationwide Survey of Physicians' Knowledge, Attitudes, and Reported Behavior . US Dept of Health, Education, and Welfare publication (NIH) 79-1056, 1979. 5. Whelton PK: Mild hypertension: Is it important? South Med J 1981;74: 979-983.Crossref 6. Weinstein MC, Stason WB: Hypertension: A Policy Perspective . Cambridge, Mass, Harvard University Press, 1976, pp 51-62. 7. Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program. JAMA 1979;242:2562-2577.Crossref 8. Relman AS: Mild hypertension: No more benign neglect. N Engl J Med 1980;302:293-294.Crossref 9. Moser M: On the management of 'mild hypertension.' Arch Intern Med 1981;141:1587-1588.Crossref 10. The pressure to treat, editorial. Lancet 1980;1:1283-1284. 11. Madhaven S, Alderman MH: The potential effect of blood pressure reduction on cardiovascular disease: A cautionary note. Arch Intern Med 1981;141:1583-1588.Crossref 12. Oliver MF: Risks of correcting the risks of coronary disease and stroke with drugs. N Engl J Med 1982;306:297-298.Crossref 13. Kaplan NM: Whom to treat: The dilemma of mild hypertension. Am Heart J 1982;101:867-870.Crossref 14. Freis ED: Should mild hypertension be treated? N Engl J Med 1982; 307:306-309.Crossref 15. Enlund H, Nissinen A, Tuomilemto J: Antihypertensive drug treatment in a middle-aged population. Hypertension 1982;4:716-724.Crossref 16. Whelton PK: Systemic hypertension, diuretics, arrhythmias and death. Am J Cardiol 1985;55:221-222.Crossref 17. Kaplan N: New approaches to the therapy of mild hypertension. Am J Cardiol 1983;51:621-627.Crossref 18. Dollery CT: Management of hypertension: Risk-benefit ratio. J Hypertension 1984;2( (suppl) ):9-12. 19. Soltero I, Tsong Y, Cooper R, et al: A survey of patterns of nonpharmacologic care for hypertensive patients, including recommendations for their children. Hypertension 1980;2:215-220.Crossref 20. Thompson GE, Alderman MH, Wassertheil-Smoller S, et al: High blood pressure diagnosis and treatment: Consensus recommendations vs actual practice. Am J Public Health 1981;71:413-415.Crossref 21. Apostolides AY, Cutter G, Draus JF, et al: Impact of hypertension information on high blood pressure control between 1973 and 1978. Hypertension 1980;2:708-713.Crossref 22. Freeman DH, D'Atri DA, Hellenbrand K, et al: The prevalence distribution of hypertension: Connecticut adults 1978-1979. J Chronic Dis 1983;36:171-181.Crossref 23. Entwisle G, Scott JC, Apostolides AY, et al: A survey of blood pressure in the state of Maryland. Prev Med 1983;12:695-708.Crossref 24. Bone LE, Levine DM, Parry RE, et al: Update on the factors associated with high blood pressure compliance. Md State Med J 1984;33: 201-204. 25. Heller RF, Rose G: Current management of hypertension in hospital. Br Med J 1977;1:1441-1442.Crossref 26. Heller RF, Rose G: Current management of hypertension in general practice. Br Med J 1977;1:1442-1444.Crossref 27. Ritchie LD, Currie AM: Blood pressure recording by general practitioners in northeast Scotland. Br Med J 1983;286:107-109.Crossref 28. Coope J: Hypertension in general practice: What is to be done? Br Med J 1984;288:87-88.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1986

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