Managing hypertension in frail oldest-old-The role of guideline use by general practitioners from 29 countries.

Roulet, Céline; Rozsnyai, Zsofia; Jungo, Katharina Tabea; A van der Ploeg, Milly; Floriani, Carmen; Kurpas, Donata; Vinker, Shlomo; Kreitmayer Pestic, Sanda; Petrazzuoli, Ferdinando; Hoffmann, Kathryn; Viegas, Rita P A; Mallen, Christian; Tatsioni, Athina; Maisonneuve, Hubert; Collins, Claire; Lingner, Heidrun; Tsopra, Rosy; Mueller, Yolanda; Poortvliet, Rosalinde K E; Gussekloo, Jacobijn; ... (2020). Managing hypertension in frail oldest-old-The role of guideline use by general practitioners from 29 countries. PLoS ONE, 15(7), e0236064. Public Library of Science 10.1371/journal.pone.0236064

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The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old.


Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey.


GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries.


Overall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used.


Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Rozsnyai, Zsófia, Jungo, Katharina Tabea, Floriani, Carmen, Streit, Sven


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




Public Library of Science


[4] Swiss National Science Foundation




Andrea Flükiger-Flückiger

Date Deposited:

22 Jul 2020 21:45

Last Modified:

15 May 2023 11:56

Publisher DOI:


PubMed ID:


Additional Information:

Roulet and Rozsnyai contributed equally to this work.




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