Implementation of Guidelines for Diagnosing and Treating Hypertension
Finlay A. McAlister
Hypertension is an important modifiable risk factor for cardiovascular disease. Despite compelling evidence for the benefits of various treatment strategies and an extensive program of public and professional education, management of hypertension remains suboptimal with marked interphysician variability and inconsistent application of clinical trial evidence. Clinical practice guidelines are often cited as a potential means to improve hypertension management, although trials evaluating the impact of guidelines for various conditions have reported mixed results. Multiple potential barriers to the successful implementation of guidelines exist: these can be broadly classified as arising from the clinician, the patient, the environment, or the guideline itself. The probability of successfully implementing a guideline is highest if multifactorial approaches are pursued, such as: 1. the generation of locally endorsed evidence-based guidelines; 2. dissemination of the guidelines by academic detailing; 3. point-of-care reminder systems; and 4. multiple reinforcements via local opinion leaders and audit with patient-specific feedback.
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