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

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.

Fig. 1: Adherence to methodological standards by hypertension guidelines. Criteria for fulfillment of methodological standards are outlined in Shaneyfelt et al. Development = the process of assembling the guideline developers and generating, formatting and targeting the guideline, Evaluation of evidence = the process of identifying, grading and summarizing the evidence, Formulation = the process of making and grading specific recommendations. CAN = 1999 Canadian Recommendations for the Management of Hypertension, JNC-VI = The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, WHO/ISH = 1999 World Health Organization–International Society of Hypertension Guidelines for the Management of Hypertension.