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Hypertension and the family physician


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Canadian Family PhysicianLe Médecin de famille canadien Vol 55: july • juillet 2009


Hypertension and the family physician

Nicholas Pimlott


The real voyage of discovery consists not in seeking new landscapes but in having new eyes.

Marcel Proust (1871-1922)


bout a year after I started practising family medi- cine, I met a retired family doctor who had prac- tised comprehensive care for more than 40 years in a small town in Pennsylvania. He inquired about how I was enjoying practice so far, and in response I lamented that it was getting a bit boring seeing the same common problems day after day—problems like hypertension, for example. He politely replied that he was never bored for a single moment in his long career and urged me to see what was interesting and challeng- ing in the commonplace. His gentle, but firm, rebuke has remained in my mind ever since.

Screening, diagnosing, treating, and the ongoing monitoring of high blood pressure results in 20 million office visits to Canadian family doctors and internists annually,1 making it the truly commonplace problem in family medicine. About 1 in 4 Canadians has high blood pressure and the prevalence of hypertension is grow- ing. In Canada, the prevalence of hypertension in people older than age 50 is more than 50%.2

Although family physicians are often criticized for not following clinical practice guidelines closely and for fail- ing to meet treatment targets for many conditions, there is strong evidence that family physicians have made great strides in screening for and diagnosis and treat- ment of hypertension over the past 2 decades.

In a commentary in this month’s issue of Canadian Family Physician (page 684), Dr Karen Tu, a family phy- sician and research scientist at the Institute for Clinical Evaluative Sciences in Toronto, Ont, provides a com- pelling case that family physicians in Canada have made substantial improvements in the diagnosis and

management of hypertension and that it is time we gave ourselves some recognition for doing so.3 Dr Tu highlights 3 research studies published in the journal this month in order to make her case. In one study from Alberta4 (page 735) and a second from Ontario5 (page 719), both of which used chart audits, hyper- tension treatment and control rates were around 85%

and 45%, respectively—a substantial improvement from the past. A third study of family physicians from Nova Scotia6 (page 728) showed that in patients with diabe- tes and hypertension average blood pressure readings were better than those reported in the United Kingdom Prospective Diabetes Study (UKPDS).7

While there is still more room for improvement, as Dr Tu outlines, it is clear that Canadian family physi- cians are paying greater attention to hypertension, with improved rates of treatment and blood pressure control.

That was the message to a callow young physician from a far wiser and more experienced colleague almost 20 years ago: When you take a strong interest in common problems, your patients benefit.

Competing interests None declared References

1. Top 10 diagnoses in Canada, 2006 [website]. IMS Health, Canada, Canadian Disease and Therapeutic Index; 2007. Available from:

www.imshealthcanada.com. Accessed 2007 Sep 21.

2. Tu K, Chen C, Lipscombe L; Canadian Hypertension Education Program Outcomes Research Taskforce. Prevalence and incidence of hypertension from 1995 to 2005: a population-based study. CMAJ 2008;178(11):1429-35.

3. Tu K. Hypertension management by family physicians. Is it time to pat our- selves on the back? Can Fam Physician 2009;55:684-5 (Eng), 686-7 (Fr).

4. Houlihan SJ, Simpson SH, Cave AJ, Flook NW, Hurlburt ME, Lord CJ, et al.

Hypertension treatment and control rates. Chart review in an academic fam- ily medicine clinic. Can Fam Physician 2009;55:735-41.

5. Tu K, Cauch-Dudek K, Chen Z. Comparison of primary care physician payment models in the management of hypertension. Can Fam Physician 2009;55:719-27.

6. Putnam RW, Buhariwalla F, Lacey K, Goodfellow M, Goodine RA, Hall J, et al.

Drug management for hypertension in type 2 diabetes in family practice. Can Fam Physician 2009;55:728-34.

7. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998;317(7160):703-13. Erratum in: BMJ 1999;318(7175):29.

Cet article se trouve aussi en français à la page 683.

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