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%, p = 0.049), and more by respondents less experienced in primary health care (PHC) (83%) compared to more experienced (74%, p = 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 (p = 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。目前针对高龄患者的诊疗方案仍存在诸多不确定性，这类群体往往伴随多种合并症。本研究旨在探究影响瑞典全科医生（general practitioners, GPs）及全科医生培训生对高龄老年高血压患者诊疗决策的相关因素。研究通过通讯稿及封闭社交媒体群组的公告，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577份已启动的问卷中，共回收有效完成问卷397份，有效回收率达69%。受访者提出可接受的血压控制范围为115–152/61–93 mmHg。在影响高血压诊疗方案选择的因素层面，所有受访者均认为患者的生活状况较医学因素更为重要，其中女性医师（80%）相较于男性医师（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%）相较经验更丰富的受访者（74%，p = 0.043）也更重视患者生活状况。除饮食指导外，80.4%~91.4%的受访者会频繁为患者提供生活方式建议。所有受访者均将合并症与心血管危险因素视为高血压诊疗决策的关键考量因素。拥有更多基层医疗经验的受访者相较于经验较少者，更认可高血压诊疗指南的实用价值（p = 0.012）。女性受访者相较男性受访者，更优先强调加强与其他护理人员的协作以及建立统一用药清单的重要性。无论是医学因素还是患者生活状况，均对全科医生及全科医生培训生的高龄老年高血压患者诊疗决策具有重要影响。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。针对高龄老年高血压患者的诊疗服务组织变革，对女性受访者而言更为关键。