Hypertension management in the oldest-old: a survey of physicians in Swedish primary health care

The prevalence of hypertension (HT) increases with age. Uncertainty remains about how to treat the oldest patients, who often suffer from multimorbidity. We explored which factors influence general practitioners’ (GPs’) and GP trainees’ treatment of hypertension among the oldest-old. GPs and GP trainees in Sweden were invited to fill out an online survey through announcements in newsletters and closed social media groups. Of the 577 questionnaires that were initiated, 397 were completed (69%). The respondents stated that acceptable blood pressure ranges were 115–152/61–93 mmHg. Regarding factors influencing choices of HT treatment, all respondents considered patient’s living conditions more important than medical factors, more so by female (80%) than by male physicians (71%, <i>p</i> = 0.049), and more by respondents less experienced in primary health care (PHC) (83%) compared to more experienced (74%, <i>p</i> = 0.043). Lifestyle recommendations, except dietary advice, were frequently offered (80.4%–91.4%). All respondents identified co-morbidity and cardiovascular risk factors as important for treatment decisions. Respondents with more PHC experience considered HT treatment guidelines more useful than those with less experience (<i>p</i> = 0.012). Improved cooperation with other caregivers and a common medication list were prioritised more by female than male respondents. Both medical factors and living conditions were important for GPs and GP trainees in making HT treatment decisions for the oldest-old. Female and less experienced respondents prioritised living conditions. Organisational changes in HT care for the oldest-old were more important to female respondents.

高血压（hypertension, HT）的患病率随年龄增长而升高。目前针对高龄老年患者的高血压诊疗仍存在诸多不确定性，这类患者往往伴随多种共病。本研究旨在探究影响全科医生（general practitioners, GPs）及全科医生培训生对高龄老年患者实施高血压诊疗的相关因素。研究通过通讯简报公告及封闭社交媒体群组，邀请瑞典的全科医生与全科医生培训生参与在线问卷调查。在启动填写的577份问卷中，共有397份完成回收，回收率达69%。受访对象认为可接受的血压范围为115–152/61–93 mmHg。在影响高血压诊疗方案选择的因素方面，所有受访者均认为患者的生活状况相较于医学因素更为重要：女性医师（80%）较男性医师（71%，*p*=0.049）更优先考量生活状况；基层医疗（primary health care, PHC）经验较少的受访者（83%）相较于经验更丰富的受访者（74%，*p*=0.043）也更重视生活状况。除饮食建议外，生活方式干预建议的给出率普遍较高（80.4%–91.4%）。所有受访者均将共病与心血管危险因素视为诊疗决策的关键依据。拥有更多基层医疗经验的受访者认为高血压诊疗指南的实用性显著高于经验较少的受访者（*p*=0.012）。相较于男性受访者，女性受访者更优先重视与其他医护人员的协作优化及统一用药清单的建立。对于高龄老年患者的高血压诊疗，医学因素与生活状况均为全科医生及全科医生培训生作出诊疗决策的重要参考。女性及基层医疗经验较少的受访者更优先考量患者生活状况。针对高龄老年患者的高血压诊疗组织架构优化，对女性受访者而言更为重要。