Hypertension management in primary health care: a survey in eight regions of Sweden

Mikko Hellgren; Patrik Wennberg; Katarina Hedin; Stefan Jansson; Staffan Nilsson; Gunnar Nilsson; Per Wändell; Kristina Bengtsson Boström

doi:10.1080/02813432.2023.2242711

Hypertension management in primary health care: a survey in eight regions of Sweden

Scand J Prim Health Care. 2023 Sep;41(3):343-350. doi: 10.1080/02813432.2023.2242711. Epub 2023 Aug 10.

Authors

Mikko Hellgren^{1

2}, Patrik Wennberg³, Katarina Hedin^{4

5

6}, Stefan Jansson^{1

2

7}, Staffan Nilsson⁵, Gunnar Nilsson³, Per Wändell⁸, Kristina Bengtsson Boström⁹

Affiliations

¹ University Health Care Research Centre, Örebro University Hospital, Örebro, Sweden.
² School of Medical Sciences, Örebro University, Örebro, Sweden.
³ Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
⁴ Futurum, Jönköping, Region Jönköping County, Sweden.
⁵ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
⁶ Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.
⁷ Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
⁸ Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.
⁹ School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.

Abstract

Purpose: To explore hypertension management in primary healthcare (PHC).

Design: Structured interviews of randomly selected PHC centres (PHCCs) from December 2019 to January 2021.

Setting: Seventy-six PHCCs in eight regions of Sweden.

Main outcome measures: Staffing and organization of hypertension care. Methods of measuring blood pressure (BP), laboratory tests, registration of co-morbidities and lifestyle advice at diagnosis and follow-up.

Results: The management of hypertension varied among PHCCs. At diagnosis, most PHCCs (75%) used the sitting position at measurements, and only 13% routinely measured standing BP. One in three (33%) PHCCs never used home BP measurements and 25% only used manual measurements. The frequencies of laboratory analyses at diagnosis were similar in the PHCCs. At follow-up, fewer analyses were performed and the tests of lipids and microalbuminuria decreased from 95% to 45% (p < 0.001) and 61% to 43% (p = 0.001), respectively. Only one out of 76 PHCCs did not measure kidney function at routine follow-ups. Lifestyle, physical activity, food habits, smoking and alcohol use were assessed in ≥96% of patients at diagnosis. At follow-up, however, there were fewer assessments. Half of the PHCCs reported dedicated teams for hypertension, 82% of which were managed by nurses. There was a great inequality in the number of patients per tenured GP in the PHCCs (median 2500; range 1300-11300) patients.

Conclusions: The management of hypertension varies in many respects between PHCCs in Sweden. This might lead to inequity in the care of patients with hypertension.

Keywords: Blood pressure; general practice; hypertension; lifestyle factors; primary health care.

Plain language summary

Hypertension is mainly handled in primary healthcare (PHC), and this study shows important dissimilarities in organization and clinical management.Several variants in techniques and measurements of blood pressure were found between PHC centres.Lifestyle, clinical and laboratory assessments decreased at follow-ups compared to at diagnosis, specifically for lipids, microalbuminuria and electrocardiograms.Nearly half of the PHC centres reported that they had dedicated hypertension teams.

MeSH terms

Blood Pressure
Humans
Hypertension* / therapy
Primary Health Care*
Surveys and Questionnaires
Sweden

Grants and funding

Funding for the registration of data was granted from local support within the Örebro region län and statistical support was funded by the Swedish state under the agreement between the Swedish government and the county councils: the ALF agreement [ALFGBG-965452].