HYPERTENSION QUESTIONNAIRE

You may assume; (1) The patients 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. ACEinhibitor Alphablocker ARB BetaBlocker Calcium Channel Blocker Diuretic Other

Comment________________________________________________________________ Scenario 2; A 65 year old white obese type II diabetic with hypercholesterolaemia. BP 165/90 ACEinhibitor Alphablocker ARB BetaBlocker Calcium Channel Blocker Diuretic Other

Comment________________________________________________________________ Scenario 3; A 72 year old female with no past medical history. BP 170/85 ACEinhibitor Alphablocker ARB BetaBlocker 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 Cardiology Hospital Physicians

Nephrology Endocrinology Elderly care GIM*

1082 33 126
13 28 28 57

540 25 73
8 17 18 30

49.9% 75.8% 57.9%

61.5% 60.7% 64.3% 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.

GENERAL CARDIOLOGY PRACTITIONERS (N=25)

ACE/ARB

(N=540)
318 (58.8%) 2 (0.3%) 67 (12.4%) 47 (8.7%) 143 (26.5%) 6 (1.1%)

OTHER HOSPITAL PHYSICIANS (N=73)

47 (64.4%) 0 (0%) 14 (19.2) 13 (17.8%) 14 (19.2%) 0 (0%)

23 (92.0%) 0 (0%) 0 (0%) 3 (12.0%) 1 (4.0%) 0 (0%)

-BLOCKERS
BETA-BLOCKERS CALCIUM CHANNEL BLOCKERS DIURETICS NONE

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 Cardiology Hospital Physicians

Nephrology Endocrinology Elderly care GIM

540 25 73
8 17 18 30

318 (58.9%) 23 (92.0%) 47 (64.4%)

5 (62.5%) 13 (76.5%) 11(61.1%) 18 (60%)

222 (41.1%) 2 (8.0%) 26 (35.6%)

3 (37.5%) 4 (23.5%) 7 (38.9%) 12 (40.0%)

p=0.003 p=0.001 p=0.079

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.)

GENERAL CARDIOLOGY PRACTITIONERS (N=25)

ACE/ARB

(N=540)
494 (91.5%) 6 (1.1%) 7 (1.3%) 67 (12.4%) 30 (5.6%) 0 (0%)

OTHER HOSPITAL PHYSICIANS (N=72*)

72 (100%) 2 (2.8%) 0 (0%) 8 (11.1%) 8 (11.1%) 0 (0%)

25 (100.0%) 0 (0%) 0 (0%) 8 (32.0%) 0 (0%) 0 (0%)

-BLOCKERS
BETA-BLOCKERS CALCIUM CHANNEL BLOCKERS DIURETICS NONE

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 Cardiology Hospital Physicians

Nephrology Endocrinology Elderly care GIM

540 25 72*
8 17 18 29

494 (91.5%) 25 (100%) 72 (100%)

8 (100%) 17 (100%) 18 (100%) 29 (100%)

46 (8.5%) 0 (0%) 0 (0%)

0 (0%) 0 (0%) 0 (0%) 0 (0%)

p<0.001 p<0.001 p<0.001

GENERAL CARDIOLOGY PRACTITIONERS (N=25)

ACE/ARB

(N=540)
50 (9.1%) 3 (0.6%) 11 (2.0%) 135 (25.0%) 361 (66.9%) 3 (0.6%)

OTHER HOSPITAL PHYSICIANS (N=72*)

14 (19.4%) 3 (4.2%) 3 (4.2%) 21 (29.2%) 43 (59.7%) 3 (4.2%)

8 (32.0%) 0 (0%) 0 (0%) 14 (56.0%) 8 (32.0%) 0 (0%)

-BLOCKERS
BETA-BLOCKERS CALCIUM CHANNEL BLOCKERS DIURETICS NONE

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 Cardiology Hospital Physicians

Nephrology

540 25 72*
8

476 (88.1%) 21 (84.0%) 62 (86.1%)

6 (75.0%)

64 (11.9%) 4 (16.0%) 10 (13.9%)

2 (25.0%)

p<0.001 p=0.01 p<0.001

Endocrinology Elderly care GIM

17 18 29

16 (94.1%) 15 (83.3%) 25 (86.2%)

1 (5.6%) 3 (16.7%) 4 (13.8%)