Treatment of hypertension in central and eastern European countries: self-reported practice of primary care physicians.

ABSTRACT

OBJECTIVES: To describe self-reported hypertension treatment among primary care physicians in central and eastern Europe and to investigate international differences. METHODS: A cross-sectional survey of primary care physicians with a questionnaire translated into various languages was carried out in nine central and eastern European countries. Three thousand physicians were randomly selected from the national registers. RESULTS: Eight hundred and sixty-seven invited primary care physicians responded. For the patients with hypertension and low cardiovascular risk, 49% of physicians reported a treatment goal of less than 140/90 mmHg (69% in Slovenia, 20% in Latvia, P < 0.001). In patients with hypertension and diabetes mellitus, blood pressure (BP) targets of less than 130/80 mmHg and less than 120/80 mmHg were reported by 47 and 48% of physicians, respectively, and significant differences between countries were revealed. Angiotensin-converting enzyme inhibitors were the most common declared drugs used on a daily basis (over 90% of physicians in all countries). Various international differences were observed among the use of diuretics, ß-blockers and drugs from other classes. An immediate initiation of pharmacotherapy was declared by 24% of physicians at a SBP level of at least 180 mmHg and 20% at DBP level of at least 110 mmHg. CONCLUSION: In hypertension treatment, some decisions made by primary care physicians from central and eastern European countries are still done without any supporting evidence from clinical trials. They have declared lower treatment goals and the initiation of pharmacotherapy at lower BP levels than recommended in international guidelines. An innovative approach to continuous medical education should be introduced and the efforts to implement guidelines in everyday practice ought to continue.