Keywords: : Hypertension, Delphi, General Practitioner

Background:

General practitioners play a crucial role in the screening, evaluation, and management of hypertension.

Research questions:

The aim of the study was to determine the level of consensus general practitioners can reach regarding the management of hypertension:
• Adherence to diagnostic recommendations
• Target blood pressure values
• Adherence to national guidelines
• Preference for fixed-dose combinations
• Consideration of comorbidities, sex, age, and risk factors

Method:

We developed a questionnaire using the Delphi method. General practitioners were recruited. A 12-month gap was maintained between the two iterations. The first took place between March 2023, and September 2023, and the second between March 2024, and May 2024. 113 GPs participated nationwide in the first iteration; 72 of them completed the second iteration questionnaire.

Results:

By 2024, consensus (67%) had been reached regarding the use of three consecutive blood pressure measurements in the office, aligning with the new ESH guidelines.
Upon first iteration there was no consensus on the necessity of home blood pressure monitoring in cases where medical therapy is not initiated immediately (61.4% agreement), by the second iteration, agreement level reached consensus treshold (69.44%).
Interestingly, for patients under 65 with uncomplicated, event-free primary hypertension, upon first iteration 75.44% of GPs (men) and 71.93% (women) agreed that initial therapy is usually combination treatment. One year later, this dropped to 69.44% and 65.28%, respectively.
In the second iteration, GPs reported more frequent use of the National eHealth Infrastructure to monitor therapy effectiveness and adherence.
Additionally, 42.1% of GPs plan to pursue board certification in hypertension (hypertensiology license exam).

Conclusions:

The Delphi study proved useful among general practitioners. It provided rapid and well-founded data on antihypertensive treatment practices.
Following the second iteration, stronger consensus may emerge regarding optimal diagnostic and therapeutic strategies.
Practice-oriented education can support the dissemination and implementation of national guidelines in everyday clinical work.

Points for discussion:

Optimal ways of knowledge dissemination and guideline implementation