An evaluation of minimal clinically important differences for the initiation of antihypertensive therapy from the perspective of Canadian patients and physicians.

Abstract

Background. Traditional hypertension guidelines from different countries or organizations often specified different treatment thresholds. These discrepancies have enormous public health implication. As the choice of treatment threshold is a utility-sensitive decision, determination of the preferences of practicing physicians and hypertensive patients is important for future policy making. Methods. A survey to determine the minimal clinically important differences (MCIDs) of patients and physicians for the initiation of antihypertensive therapy in the primary prevention of cardiovascular disease. Physicians were randomly selected from the population of all family physicians in the Ottawa-Carleton region and hypertensive patients without symptomatic cardiovascular disease were recruited from a convenience sample of five family physicians and four general internists. Both groups were presented with six hypothetical scenarios which described the same blood pressure (150/95 mm Hg) but different baseline cardiovascular risks (2%, 5%, and 10% in five years, and 15%, 30%, and 50% in twenty years). For each scenario, subjects were asked whether they would prescribe/accept treatment and, if they would, a probability trade-off technique was used to determine their MCID for antihypertensive therapy. (Abstract shortened by UMI.)