Hypertension guidelines: criteria that might make them more clinically useful

Abstract Cardiovascular disease prevention depends on reduction of risk factors, including hypertension. Guidelines designed to improve management of hypertension are widely available. Their purpose is to assemble the available data from basic biomedical science, epidemiology, and clinical science in an accessible form with which physicians and patients can make reasoned decisions for individual cases. However, guidelines have been neither widely accepted, nor effectively implemented. We recommend a strategy for guideline preparation designed to yield a product more user friendly, accessible, and effective. Guideline recommendations and the evidence used to make them should be based on an explicit grading system. Relevant clinical as well as nonclinical factors must be considered. Moreover, because the goal of antihypertensive therapy is to prevent cardiovascular events, and the likelihood of such events is determined by multifactor or absolute risk assessment, risk, rather than level of blood pressure (BP), should determine the need for therapy. Similarly, the benefit of therapy must be assessed by reduction in cardiovascular disease morbidity and mortality.