Keele Research Repository

<h4>Background: </h4> The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear while lacking guidelines providing specific recommendations.Aim, Objectives To investigate guideline use in general practitioners (GPs) and if guideline use relates to different decisions when managing hypertension in frail oldest-old.Design/Setting Cross-sectional study.Methods GPs participated in a survey with case-vignettes of frail oldest-old varying in systolic blood pressure (SBP) and cardiovascular disease (CVD). GPs in Europe, Brazil, Israel and New Zealand were invited. We compared the percentage of GPs using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GP’s gender, years of experience and prevalence of oldest-old in their practice), we used a mixed-effects regression model accounting for clustering within countries.Results Overall, 2,543 GPs from 29 countries were included. About 60% 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 guidelines use, ranging from 25% to 90% of the GPs. However, there was no difference in decisions about treatment hypertension in frail oldest-old patients between GPs that used or not used guidelines nor which guideline they used.Conclusion Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users. 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.