BMJ 1996;313:93-96 (13 July)

General practice

What constitutes controlled hypertension? Patient based comparison of hypertension guidelines

T P Fahey, lecturer in primary care,a T J Peters, senior lecturer in medical statistics a

a Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: Dr Fahey.

Abstract

Objectives: To investigate and quantify the extent to which variations in guidelines influence assessment of control of hypertension.
Design: Cross sectional study. Selected patients had hypertension assessed as controlled or uncontrolled with guidelines from New Zealand, Canada, the United States, Britain, and the World Health Organisation.
Setting: 18 general practices in Oxfordshire.
Subjects: 876 patients with diagnosed hypertension and taking antihypertensive drugs.
Main outcome measures: Proportion of patients with controlled hypertension according to each set of guidelines.
Results: The proportion of patients with controlled hypertension varied from 17.5% to 84.6% with the different guidelines after adjustment for the sampling method. All five sets of guidelines agreed on the classification for 31% (277) of the patients. The New Zealand guidelines calculate an absolute risk of a cardiovascular event. When this was taken as the standard half of the patients with uncontrolled hypertension by the United States criteria would be treated unnecessarily and 31% of those classified as having controlled hypertension by the Canadian guidelines would be denied beneficial treatment.
Conclusions: Hypertension guidelines are inconsistent in their recommendations and need to make clear the absolute benefits and risks of treatment.

Key messages

  • This study applied the recommendations of guidelines from New Zealand, Canada, the United States, Britain, and the WHO to a sample of 879 hypertensive patients

  • The proportion with controlled hypertension varied between 17.5% and 84.6% according to which set of guidelines was followed

  • Overall, the five sets of guidelines agreed for 31% of the patients

  • Hypertension guidelines are inconsistent and unclear on the absolute benefits of treatment


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