Implementation of Clinical Hypertension Guidelines and Single Pill Combinations: A Qualitative Study in Australian General Practice

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BACKGROUND: Hypertension is the leading cause of preventable deaths worldwide, yet blood pressure (BP) control remains poor in Australia when compared to other similar higher income countries. This study aims to explore general practitioners' (GPs) perceptions of hypertension management and single pill combination (SPC) to identify barriers and facilitators to guideline implementation and SPC use in Australia. METHODS: Semi-structured interviews were conducted with 20 GPs (June-July 2024). Participants were purposively sampled to ensure diversity (age, sex, experience, location). Interviews explored diagnosis, treatment, monitoring, and attitudes toward guidelines and single pill combinations (SPCs). Transcripts were analyzed using a combined deductive-inductive approach guided by the Consolidated Framework for Implementation Research. RESULTS: GPs demonstrated limited awareness of recent international guideline updates and relied predominantly on the 2016 Australian guidelines, with most initiating treatment with monotherapy and targeting BP < 140/90 mmHg. SPCs were rarely used early and were perceived as difficult to titrate. Practice-level audits of BP control were absent, team-based care was inconsistently implemented. Therapeutic inertia and non-adherence to antihypertensive therapy-key barriers to BP control-were rarely acknowledged. Younger and academically affiliated GPs were more receptive to SPCs and lower BP targets, while experienced GPs often favored conservative, stepwise escalation partly due to concerns of side-effects. CONCLUSIONS: Whilst hypertension management in Australian general practice overall aligns with current national guidelines, an update to the 2016 guidelines is urgently needed to reflect best-evidence, particularly on the use of SPCs and strengthening of team-based care to improve BP control.

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