title: Guidelines adherence and hypertension control at a tertiary hospital in Malaysia.
abstract: OBJECTIVE
  Existing literature suggests that doctors' poor adherence with guidelines is one of the major contributing factors to suboptimal control of hypertension. This study aims to evaluate doctors' adherence with Malaysian clinical practice guideline (CPG 2008) in a tertiary care hospital, and factors associated with guideline adherence and hypertension control.
  
  
  METHODS
  This was a cross-sectional study conducted at Hospital Pulau Pinang, Penang, Malaysia. Prescriptions written by 26 enrolled doctors to 650 established hypertensive outpatients (25 prescriptions per enrolled doctor) were noted on visit 1 along with patients' demographic and clinical data. The noted prescriptions were classified either as compliant or non-compliant to CPG (2008). Five hundred twenty (80%) of the enrolled patients (20 patients per enrolled doctor) were followed for one more visit. Blood pressure (BP) noted on visit 2 was related to the prescription written on visit 1. SPSS 16 (SPSS Inc., Chicago, IL, USA) was used for data analysis.
  
  
  RESULTS
  Three hundred forty-nine (67.1%) patients received guidelines compliant pharmacotherapy. In multivariate analysis, hypertension clinic had significant negative association with guidelines adherence. Two hundred sixty-five patients (51%) were at goal BP on visit 2. In multivariate analysis, angiotensin-converting enzyme inhibitors and guidelines adherence had significant positive, while renal disease, diabetes mellitus and diabetic clinic had significant negative association with hypertension control.
  
  
  CONCLUSIONS
  An overall fair level of adherence with guidelines and better control of hypertension was observed. Guidelines compliant practices resulted in better control of hypertension. The gaps between what guidelines recommend and clinical practice were especially seen in the pharmacotherapy of uncomplicated hypertension and hypertension with diabetes mellitus and renal disease.
authors.affiliation: Researcher Lecturer, Department of Clinical Pharmacy Researcher, Department of Physiology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia Professor Professor, Department of Clinical Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, Bandar Puncak Alam, Selangor, Malaysia Head of One Stop Centre, Clinical Research Centre, Ministry of Health, Pulau Pinang, Malaysia.
authors.forename: Nafees
authors.initials: N
authors.lastname: Ahmad
authors.forename: Yahaya
authors.initials: Y
authors.lastname: Hassan
authors.forename: Balamurugan
authors.initials: B
authors.lastname: Tangiisuran
authors.forename: Ong Loke
authors.initials: OL
authors.lastname: Meng
authors.forename: Noorizan
authors.initials: N
authors.lastname: Abd Aziz
authors.forename: Fiaz-ud-Din
authors.initials: FU
authors.lastname: Ahmad
authors.forename: Muhammad
authors.initials: M
authors.lastname: Atif
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D018660:Blood Pressure Monitoring, Ambulatory / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents