From clinical observation to assessment of practices: guidelines for hypertension management

Hypertension is highly prevalent and one of the main risk factors for cardiovascular diseases. It has been demonstrated that anti hypertensive treatment is effective to prevent cardiovascular events. Advances have been made in this field for 50 years and the knowledge and management of hypertension has been modified continuously with increase of related costs. Therefore hypertension is one of the favorite themes for guidelines and indeed several guidelines have been published on this theme regularly. Despite this, a high percentage of treated hypertensive patients remains uncontrolled. Several reasons have been raised for not implementing guidelines: these guidelines are often littte-known because of their large number and their bad distribution. A systematic analysis of the last guidelines showed also they were structurally different with a small percentage of identical references and they provided sometimes different practical conclusions. Finally, clinical inertia is partly responsible for these insufficient results. As the current form of the guidelines has a limited impact on the medical practice, we should find other methods to improve their implementation. (C) 2009 Elsevier Masson SAS et Association Societe de Nephrologie. All rights reserved.