General practitioners' perspectives, preferences, and practices in prescribing antihypertensive medication in primary, uncomplicated hypertension

Background International guidelines consider most antihypertensive medication (AHM) classes as equivalent options for treating primary hypertension. However, limited research has examined whether general practitioners (GPs) share this view or have specific prescribing preferences. Understanding GPs' perspectives is crucial for identifying how guidelines are implemented in daily practice. This study explores the perspectives, preferences, and prescribing practices of Dutch GPs regarding AHM classes in patients with primary hypertension who have no cardiovascular comorbidities or diabetes. Methods We conducted a qualitative study with semi-structured interviews among Dutch GPs. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Results We interviewed 18 Dutch GPs (56% female) and identified three key themes: contextual factors when initiating treatment, preferences for AHM classes, and considerations on combination therapy. GPs consider lifestyle modifications, patient age, and initial blood pressure (BP) when deciding on treatment. Most GPs do not view all AHM classes as interchangeable, with their preferences shaped by perceived efficacy, side effects, and patient-specific factors, including ethnicity and patient preferences. GPs often favour a gradual titration approach, starting with one class before adjusting the dosage or adding another. Conclusion GPs adopt a multifaceted, patient-centred approach to hypertension, prioritizing lifestyle interventions and weighing short-term risks against long-term benefits. We identified several discrepancies between guideline recommendations and everyday practice - particularly regarding the perceived non-equivalence of AHM classes and limited support for initiating combination therapy. Incorporating GPs' perspectives into guideline development may lead to more practical, tailored recommendations that improve adherence and patient outcomes in real-world care.