Simple, shared guidelines raise the quality of antihypertensive treatment in routine care.
OBJECTIVE
To assess the impact of simple, collectively produced, evidence-based guidelines on optimizing the choice of antihypertensive drugs in routine care.


RESULTS
Forty-eight physicians agreed to produce and test these guidelines for 1 year in their daily practice on a random sample of 1049 treated hypertensive patients (intervention group). A control group of 42 general practitioners recruited and followed up for 1 year a parallel nonintervention cohort of 722 treated hypertensive patients. After 1 year of follow-up, the patients in the nonintervention group had no changes in any of the predefined end points. In the intervention group, the use of diuretics and beta-blockers--drugs with documented preventive efficacy--increased, respectively, from 48.3% to 57.6% and from 22.0% to 29.7%; and the proportion of hypertensive patients receiving indicated drugs (with no contraindications) rose from 66.1% to 73.0%. The prescription of poorly tolerated drugs decreased from 12.4% to 7.2%, and noncompliance with the antihypertensive therapy decreased from 5.2% to 3.8%. In the intervention group, both systolic and diastolic blood pressure control improved (systolic pressure <140 mm Hg, from 23.3% to 39.5%; diastolic pressure <90 mm Hg, from 65.4% to 87.4%).


CONCLUSIONS
An intervention strategy based on the collaborative production of simple evidence-based guidelines appears to be effective in raising the quality of antihypertensive therapy in routine care.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004232:Diuretics / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011787:Quality of Health Care
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics