LAUSR

Objective: Balanced clinical information to patients about treatment benefits and harms can help the patient to develop realistic expectations of treatment effects. We assessed concordance between patients’ and physicians’ estimations of the risk of hypertension complications during a regular follow-up appointment in a randomized study at 55 primary health care centres and 11 clinics of internal medicine in Sweden 1996. Patients then rated the benefits of treatment higher than did their physicians. Objective: To compare actual outcome of hypertension-related complications after 10 years of treatment with the original estimation of 10-year risk by patients and physicians. Design and method: Patients with drug-treated hypertension as main diagnose were included. The individual estimations by patients (n = 967) and their attending physicians (n = 212) were assessed for major complications to hypertension (heart failure – HF; acute myocardial infarction – AMI; stroke; and death). The mean age was 62 years for both men (n = 427) and women (n = 540). Estimations were recorded on a visual-analog-scale with the end-points representing 0 = no, and 100 mm = 100% probability for complication during a 10-year period. Data on morbidity and mortality for each patient were collected from the national registers for the period of 1996–2006 and compared with the estimated risk at baseline. Results: After 10 years, 192 (20%) patients had died, 74 (8%) with either HF, AMI or stroke as main or contributing cause of death. 142 (15%) were diagnosed with heart failure, 81 (8%) with myocardial infarction and 105 (11%) with stroke. The assessments of patients of the 10-year risk of morbidity with treated hypertension were close to the actual outcome for HF (14% vs. 15%, p = 0.38), but higher for AMI (16% vs. 8%, p < 0.001) and stroke (16% vs. 11% p < 0.001) than the actual outcome. The assessments of physicians were consistently higher (HF 24%, p < 0.001; AMI 27%, p < 0.001; stroke 25%, p < 0.001) than the actual outcome, and differed significantly from the assessment of the patients for all three complications. Conclusions: In general, patients with hypertension assessed the 10-year risk with treated hypertension better than physicians who estimated a significantly higher risk for hypertension-related morbidity.