Non-pharmacological management of hypertension: results from interviews with 100 general practitioners

OBJECTIVETo describe the type and level of non-pharmacological management offered by general practitioners for essential hypertension. DESIGNAn open-ended interviewer-administered survey using a standard case of a 60-year-old man with essential hypertension. Seventy interviews were conducted face-to-face and 30 by telephone. SETTINGAuckland general practices. SUBJECTSA random sample of 100 Auckland general practitioners. MAIN OUTCOME MEASURESAspects of the medical histories of patients, physical examination, laboratory testing and treatment relevant to non-pharmacological management. RESULTSThere was an 84% response rate. Most general practitioners reported offering non-pharmacological management at the first consultation before prescribing medication. However, few offered detailed programmes. Dietary therapy, restriction of alcohol consumption and exercise were suggested by most general practitioners. Restriction of sodium intake and behavioural therapy were less popular non-pharmacological interventions. The median number of visits of patients to a general practitioner before drugs were prescribed was five, which is in keeping with guidelines. The median number of days from the first visit to prescription of drug therapy was 42 (range 2-341). The clinical advice given by the majority of participants was consistent with current guidelines on the treatment of hypertension but the range of advice given was wide. CONCLUSIONSThe results suggest that general practitioners are aware of non-pharmacological interventions for the management of hypertension. They report making routine use of non-pharmacological therapies for blood pressure reduction and other health benefits early in the clinical process before considering pharmacological therapy. These non-pharmacological therapies are not delivered with well-defined and detailed programmes.