Hypertension management in the oldest-old: a survey of physicians in Swedish primary health care.

INTRODUCTION

The prevalence of hypertension (HT) increases with age. Uncertainty remains about how to treat the oldest patients, who often suffer from multimorbidity.

AIM: We explored which factors influence general practitioners' (GPs') and GP trainees' treatment of hypertension among the oldest-old.

METHODS

GPs and GP trainees in Sweden were invited to fill out an online survey through announcements in newsletters and closed social media groups.

RESULTS

Of the 577 questionnaires that were initiated, 397 were completed (69%). The respondents stated that acceptable blood pressure ranges were 115-152/61-93 mmHg. Regarding factors influencing choices of HT treatment, all respondents considered patient's living conditions more important than medical factors, more so by female (80%) than by male physicians (71%, p = 0.049), and more by respondents less experienced in primary health care (PHC) (83%) compared to more experienced (74%, p = 0.043). Lifestyle recommendations, except dietary advice, were frequently offered (80.4%-91.4%). All respondents identified co-morbidity and cardiovascular risk factors as important for treatment decisions. Respondents with more PHC experience considered HT treatment guidelines more useful than those with less experience (p = 0.012). Improved cooperation with other caregivers and a common medication list were prioritised more by female than male respondents.

CONCLUSIONS

Both medical factors and living conditions were important for GPs and GP trainees in making HT treatment decisions for the oldest-old. Female and less experienced respondents prioritised living conditions. Organisational changes in HT care for the oldest-old were more important to female respondents.