[Local variability in the guidelines for hypertension screening, diagnosis and baseline assessment in 40 health centers].
BACKGROUND
To identify and to compare the recommendations of the currently existing clinical protocols for arterial hypertension (HT) screening, diagnosis and baseline study in the Murcia Region, Spain, in order to assess their validity and reliability.


METHODS
Structured comparative description of guidelines in Clinical Protocols for HT (n = 40) from all Health Centers in the Region. Comparative description of the Health Centers Clinical Protocols and national and international reference documents regarding HT screening, diagnosis and baseline assessment is performed.


RESULTS
Target population for screening ranged from aged > or = 14 years (24 centers) to > 20 (1 center). Screening procedure was not described in 3 centers and screening periodicity varied from 6 months to 5 years, with differences by age and by concurrent risk factors in some protocols. Diagnosis norms differed by age in only 11 protocols; blood pressure (BP) exams for diagnosis varied from 3 to 5 and there were 12 different HT figures for immediate diagnosis and treatment. Baseline study varied greatly; we found a total of 7 recommended items for anamnesis, 11 for physical exam, 19 for blood tests, 4 for urine tests, and 7 for other tests; only the electrocardiogram was common to all protocols. There was also some disagreement in the national and international reference guidelines whose scientific evidence was not always explicitly considered.


CONCLUSIONS
There is a wide local variation in norms for HT screening, diagnosis, and baseline study. If the Centers follow their own protocols, the same patient may be or may not be diagnosed depending on the Center he visits; additionally, there would be big differences in the process and resources needed for HT control. This variation casts doubt on the protocols validity and reliability at regional level and underscores the need for critically reviewing the validity of existing protocols.
Saturno Hernández
P J
PJ
UD Medicina Preventiva y Salud Pública, Murcia. psaturno@fcu.um.es
Antón Botella
J J
JJ
Murcia Payá
J F
JF
D000328:Adult; D002391:Catchment Area, Health; D003954:Diagnostic Services / Q000458:organization & administration*; D004562:Electrocardiography; D017408:Guidelines as Topic; D006296:Health Services; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D008403:Mass Screening; D010507:Periodicity; D015203:Reproducibility of Results; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology