T P Fahey1, T J Peters. 1. Department of Social Medicine, University of Bristol.
Abstract
OBJECTIVES: To investigate and quantify the extent to which variations in guidelines influence assessment of control of hypertension. DESIGN: Cross sectional study. Selected patients had hypertension assessed as controlled or uncontrolled with guidelines from New Zealand, Canada, the United States, Britain, and the World Health Organisation. SETTING: 18 general practices in Oxfordshire. SUBJECTS: 876 patients with diagnosed hypertension and taking antihypertensive drugs. MAIN OUTCOME MEASURES: Proportion of patients with controlled hypertension according to each set of guidelines. RESULTS: The proportion of patients with controlled hypertension varied from 17.5% to 84.6% with the different guidelines after adjustment for the sampling method. All five sets of guidelines agreed on the classification for 31% (277) of the patients. The New Zealand guidelines calculate an absolute risk of a cardiovascular event. When this was taken as the standard half of the patients with uncontrolled hypertension by the United States criteria would be treated unnecessarily and 31% of those classified as having controlled hypertension by the Canadian guidelines would be denied beneficial treatment. CONCLUSIONS: Hypertension guidelines are inconsistent in their recommendations and need to make clear the absolute benefits and risks of treatment.
OBJECTIVES: To investigate and quantify the extent to which variations in guidelines influence assessment of control of hypertension. DESIGN: Cross sectional study. Selected patients had hypertension assessed as controlled or uncontrolled with guidelines from New Zealand, Canada, the United States, Britain, and the World Health Organisation. SETTING: 18 general practices in Oxfordshire. SUBJECTS: 876 patients with diagnosed hypertension and taking antihypertensive drugs. MAIN OUTCOME MEASURES: Proportion of patients with controlled hypertension according to each set of guidelines. RESULTS: The proportion of patients with controlled hypertension varied from 17.5% to 84.6% with the different guidelines after adjustment for the sampling method. All five sets of guidelines agreed on the classification for 31% (277) of the patients. The New Zealand guidelines calculate an absolute risk of a cardiovascular event. When this was taken as the standard half of the patients with uncontrolled hypertension by the United States criteria would be treated unnecessarily and 31% of those classified as having controlled hypertension by the Canadian guidelines would be denied beneficial treatment. CONCLUSIONS:Hypertension guidelines are inconsistent in their recommendations and need to make clear the absolute benefits and risks of treatment.
Authors: I D Graham; S Beardall; A O Carter; J Glennie; P C Hébert; J M Tetroe; F A McAlister; S Visentin; G M Anderson Journal: CMAJ Date: 2001-07-24 Impact factor: 8.262
Authors: B D Frijling; T H Spies; C M Lobo; M E Hulscher; B B van Drenth; J C Braspenning; A Prins; J C van der Wouden; R P Grol Journal: Br J Gen Pract Date: 2001-01 Impact factor: 5.386