HYPERTENSION QUESTIONNAIRE

You may assume;

(1)  The patient’s described below have had a recorded elevated blood pressure recording on three separate occasions.

(2)  Lifestyle modifications have been optimised.

(3)  The patient is on no other anti-hypertensive medication.

(4)  The patient has essential hypertension.

(5)  The patient has no contra-indications to any of the medications.

Please identify your job title

General Practitioner Y

Hospital Physician Y Specialty______

For the following scenarios please choose which class of drug(s) you would prescribe in the following clinical scenario.

Please circle as appropriate.

Scenario 1; A 42 year old man who is otherwise well. BP 165/95.

ACE-inhibitor / Alpha-blocker / ARB / Beta-Blocker / Calcium Channel Blocker / Diuretic / Other

Comment______

Scenario 2; A 65 year old white obese type II diabetic with hypercholesterolaemia. BP 165/90

ACE-inhibitor / Alpha-blocker / ARB / Beta-Blocker / Calcium Channel Blocker / Diuretic / Other

Comment______

Scenario 3; A 72 year old female with no past medical history. BP 170/85

ACE-inhibitor / Alpha-blocker / ARB / Beta-Blocker / Calcium Channel Blocker / Diuretic / Other

Comment______

Table 1; Survey response rates from different doctor groups. * GIM – General Internal Medicine. Responders comprised Gastroenterology (7), Respiratory medicine (8) and general medicine (15).

Number surveyed / Response rate / Percentage
General Practitioners / 1082 / 540 / 49.9%
Cardiology / 33 / 25 / 75.8%
Hospital Physicians / 126 / 73 / 57.9%
Nephrology / 13 / 8 / 61.5%
Endocrinology / 28 / 17 / 60.7%
Elderly care / 28 / 18 / 64.3%
GIM* / 57 / 30 / 52.6%

Table 2; Survey results for scenario 1: A 42 year old white man with no past medical history and a blood pressure of 165/95 mmHg.

CARDIOLOGY
(N=25) / GENERAL PRACTITIONERS
(N=540) / OTHER HOSPITAL PHYSICIANS
(N=73)
ACE/ARB / 23 (92.0%) / 318 (58.8%) / 47 (64.4%)
α-BLOCKERS / 0 (0%) / 2 (0.3%) / 0 (0%)
BETA-BLOCKERS / 0 (0%) / 67 (12.4%) / 14 (19.2)
CALCIUM CHANNEL BLOCKERS / 3 (12.0%) / 47 (8.7%) / 13 (17.8%)
DIURETICS / 1 (4.0%) / 143 (26.5%) / 14 (19.2%)
NONE / 0 (0%) / 6 (1.1%) / 0 (0%)

Table 3; Proportion of physicians who selected ACE-Inhibitor/Angiotensin Receptor Blocker (ACE/ARB) over all other options in scenario 1.

Number responded / Number who selected
ACE/ARB / Number who did not select ACE/ARB / Probability of choosing ACE/ARB over any other option
(Chi-square)
General Practitioners / 540 / 318 (58.9%) / 222
(41.1%) / p=0.003
Cardiology / 25 / 23
(92.0%) / 2
(8.0%) / p=0.001
Hospital Physicians / 73 / 47
(64.4%) / 26
(35.6%) / p=0.079
Nephrology / 8 / 5 (62.5%) / 3 (37.5%)
Endocrinology / 17 / 13 (76.5%) / 4 (23.5%)
Elderly care / 18 / 11(61.1%) / 7 (38.9%)
GIM / 30 / 18 (60%) / 12 (40.0%)

Table 4; Survey results for scenario 2: A 65 year old white obese type II diabetic with hypercholesterolaemia and a blood pressure of 165/90 mmHg. (* One GIM physician answered scenario 1 but did not answer scenarios 2 or 3.)

CARDIOLOGY
(N=25) / GENERAL PRACTITIONERS
(N=540) / OTHER HOSPITAL PHYSICIANS
(N=72*)
ACE/ARB / 25 (100.0%) / 494 (91.5%) / 72 (100%)
α-BLOCKERS / 0 (0%) / 6 (1.1%) / 2 (2.8%)
BETA-BLOCKERS / 0 (0%) / 7 (1.3%) / 0 (0%)
CALCIUM CHANNEL BLOCKERS / 8 (32.0%) / 67 (12.4%) / 8 (11.1%)
DIURETICS / 0 (0%) / 30 (5.6%) / 8 (11.1%)
NONE / 0 (0%) / 0 (0%) / 0 (0%)

Table 5; Proportion of physicians who selected ACE/ARB over all other options in scenario 2.

Number responded / Number who selected
ACE/ARB / Number who did not select ACE/ARB / Probability of choosing ACE/ARB over any other option
(Chi-square)
General Practitioners / 540 / 494 (91.5%) / 46
(8.5%) / p<0.001
Cardiology / 25 / 25
(100%) / 0
(0%) / p<0.001
Hospital Physicians / 72* / 72
(100%) / 0
(0%) / p<0.001
Nephrology / 8 / 8 (100%) / 0 (0%)
Endocrinology / 17 / 17 (100%) / 0 (0%)
Elderly care / 18 / 18 (100%) / 0 (0%)
GIM / 29 / 29 (100%) / 0 (0%)
CARDIOLOGY
(N=25) / GENERAL PRACTITIONERS
(N=540) / OTHER HOSPITAL PHYSICIANS
(N=72*)
ACE/ARB / 8 (32.0%) / 50 (9.1%) / 14 (19.4%)
α-BLOCKERS / 0 (0%) / 3 (0.6%) / 3 (4.2%)
BETA-BLOCKERS / 0 (0%) / 11 (2.0%) / 3 (4.2%)
CALCIUM CHANNEL BLOCKERS / 14 (56.0%) / 135 (25.0%) / 21 (29.2%)
DIURETICS / 8 (32.0%) / 361 (66.9%) / 43 (59.7%)
NONE / 0 (0%) / 3 (0.6%) / 3 (4.2%)

Table 6; Survey results for scenario 3: A 72 year old white female with no past medical history and a blood pressure of 175/80 mmHg. (* One GIM physician answered scenario 1 but did not answer scenarios 2 or 3.)

Table 7; Proportion of physicians who selected Calcium Channel Blocker (CCB)/Diuretic over all other options in scenario 3.

Number responded / Number who selected
CCB/Diuretic / Number who did not select CCB/Diuretic / Probability of choosing CCB/Diuretic over any other option
(Chi-square)
General Practitioners / 540 / 476 (88.1%) / 64
(11.9%) / p<0.001
Cardiology / 25 / 21
(84.0%) / 4
(16.0%) / p=0.01
Hospital Physicians / 72* / 62
(86.1%) / 10
(13.9%) / p<0.001
Nephrology / 8 / 6 (75.0%) / 2 (25.0%)
Endocrinology / 17 / 16 (94.1%) / 1 (5.6%)
Elderly care / 18 / 15 (83.3%) / 3 (16.7%)
GIM / 29 / 25 (86.2%) / 4 (13.8%)

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