title: Hypertension guidelines and their effects on the health system.
abstract: BACKGROUND
  Hypertension guidelines, which have existed for many years and primarily used in the USA, Canada and Great Britain, are now becoming an issue in Germany. Strong efforts are presently underway for a German version comparable to the guidelines developed for the mentioned countries. The development of guidelines is a part of the implementation system of guidelines in Germany. It covers the mode of operation of the AWMF (work community of the scientific medical subject companies) with the clearinghouse for guidelines (CLA) and the cooperation with the centre for medical quality (ÄZQ). In the HTA report the real use of the hypertension guidelines shall be investigated for Germany from the development trends and further possibilities of use according to a medical applicability. Economic issues and an optimisation of use are also discussed.
  
  
  OBJECTIVE
  THE FOLLOWING QUESTIONS SHALL BE ANSWERED IN PARTICULAR: How much are the guidelines used concerning hypertension? Can effects (or their influence) be established on the medical procedures? Are there statements available about costs and cost effectiveness? Are there recommendations for further use?
  
  
  METHODS
  To answer these questions, a comprehensive literature search was done. No empirical investigation was carried out. From this enquiry 206 articles were checked in detail but not all of them were available in full text. Only those publications which directly dealt with high blood pressure guidelines or articles with a direct reference to the topic have been considered in the HTA report. Publications concerning screening or methods of prevention, medical studies of the hypertension syndrome without a direct reference to guidelines and publications concerned with putting guidelines into action were excluded.
  
  
  RESULTS
  After an analysis of the selected literature addressing the topic of hypertension guidelines, it was evident that the use of these guidelines cannot be gathered from existing literature at the present time. One can assume from international studies with analogical reasoning that these are confessed and have a high level of acceptance in the medical community. Unfortunately the actual usage is not represented satisfactorily in the scientific literature. The effects of the guidelines on the medical procedures seem to be very strongly individual and the analyses to the compliance show at least an observable effect within the last few years. No publications could be found for the cost effectiveness of the guidelines. The actual compliance with guidelines seems to be in relation with the duration of the professional practice. It seems the shorter the professional practice takes place, the stronger the guidelines are adhered.
  
  
  CONCLUSIONS
  At present, there are only a few notes for the German health service regarding the actual effect of the hypertonus guidelines. However, the reason is not that the effect would not be possibly strong but at the methodical challenge to evaluate the sustaining effects of the application of the hypertonus guidelines. For this reason the literature is very rare regarding this topic. For Germany it can be derived by analogical reasoning from foreign studies that guidelines will facilitate a more and more essential contribution to the design of the health system. Considering that primarily younger physicians accepted guidelines mode, the further construction, update and implementation of guidelines are essential, particularly with regard to the quality assurance. Straight guidelines can express a standard of the quality of a health system as a benchmark. The existence of guidelines or the lack thereof is considered also as a quality indicator of a health system at the organisation for economic cooperation and development (OECD).
  
  
  CONCLUSIONS
  Guidelines should be evaluated - especially the hypertonus guideline. Also further development and implementation should be emphasised. Methodically oriented work to the approach is pretty recent. It is undeniable that guidelines represent a very essential and important contribution for the successful dealing with significant morbidity problems in a health system. The fact that primarily younger doctors more frequently adopt, employ and adhere to guidelines leads to the assumption that expected sustainability for practical use will increase. Furthermore intensified use of guidelines can be considered in the "mainstream" of the development of the public health system also in an international perspective. Not one single publication contradicts that a further acquirement, update and distribution of guidelines for the use of practices is necessary. The importance of the guideline is also not questioned in any article.
authors.affiliation: ARWIG (Arbeitskreis für wissenschaftliche Gesundheitsversorgung), Wien, Österreich.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Frank
authors.forename: Brigitte
authors.initials: B
authors.lastname: Konta