NEW YORK (Reuters Health) - Doctors may not be treating high blood pressure as aggressively as they could, new study findings suggest.

The shortfall could have a large impact on public health, as uncontrolled high blood pressure is a key risk factor for heart disease, stroke and kidney disease, researchers say.

Their study of patient visits to one Detroit medical group found that patients who had had documented high blood pressure, or hypertension, for at least the past 6 months were started on medication or had their medication changed only 38% of the time.

The most common reason doctors cited for this inaction was that they were "satisfied" with the patient's blood pressure, the study authors report in the February 25th issue of the Archives of Internal Medicine.

This, despite the fact that all the doctors were familiar with the national guidelines on managing high blood pressure, and a majority said they usually followed them.

"Our findings seem to suggest that physicians are familiar with the guidelines for treating hypertension but do not implement this knowledge into their everyday practice," write Dr. Susan A. Oliveria, of Memorial Sloan-Kettering Cancer Center in New York, and colleagues.

Specifically, the investigators found that many doctors were "willing to accept" an elevated systolic blood pressure--the top number in blood pressure reading. According to US guidelines, systolic readings should be below 140 mm Hg, while diastolic values--the bottom number in a blood pressure reading--should be below 90 mm Hg.

But when Oliveria's team looked at cases where the doctor was satisfied with a patient's blood pressure and made no treatment changes, 93% involved systolic readings at or above 140.

"Our findings...suggest that physicians place more importance on the diastolic blood pressure reading than the systolic," the researchers conclude.

But while in the past, diastolic pressure was thought to be the more important health indicator, more recent research has shown otherwise. Systolic blood pressure now appears to be the better predictor of coronary artery disease, heart failure, stroke and death, Dr. Jerome D. Cohen of Saint Louis University in St. Louis, Missouri, notes in an accompanying editorial.

Cohen points out that a patient's individual circumstances clearly must guide treatment, and "physician judgment should rightfully prevail."

But, he adds, "there are literally millions of hypertensive patients who can and should be treated and who are not now being treated or controlled."

According to Cohen, recent national survey findings indicate little more than one quarter of Americans with high blood pressure have their condition adequately controlled. He notes that control need not come from drugs alone, as diet changes and exercise can help lower blood pressure.

The current study involved 231 patients with uncontrolled hypertension, about half of whom were white and 30% were black.

Some co-authors on the study are with the drug company Bristol-Myers Squibb in Princeton, New Jersey.

SOURCE: Archives of Internal Medicine 2002;162:413-420.

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