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The management of hypertension in Canada: a review of current guidelines, their shortcomings and implications for the future

Finlay A. McAlister^*, Norman R.C. Campbell, Kelly Zarnke, Mitchell Levine and Ian D. Graham^¶

From *the Division of General Internal Medicine, University of Alberta, Edmonton, Alta.; the Division of General Internal Medicine, University of Calgary, Calgary, Alta.; the Division of General Internal Medicine, London Health Sciences Centre, London, Ont.; the Centre for the Evaluation of Medicines, McMaster University, Hamilton, Ont.; and ¶the Clinical Epidemiology Unit, Loeb Health Research Centre, Ottawa, Ont.

Abstract

CLINICIANS ARE EXPOSED to numerous hypertension guidelines. However, their enthusiasm for these guidelines, and the impact of the guidelines, appears modest at best. Barriers to the successful implementation of a guideline can be identified at the level of the clinician, the patient or the practice setting; however, the shortcomings of the guidelines themselves have received little attention. In this paper, we review the hypertension guidelines that are most commonly encountered by Canadian clinicians: the "1999 Canadian Recommendations for the Management of Hypertension," "The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" in the United States and the "1999 World Health Organization–International Society of Hypertension Guidelines for the Management of Hypertension." The key points of these guidelines are compared and the shortcomings that may impede their ability to influence practice are discussed. The main implications for future guideline developers are outlined.

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