Simple, shared guidelines raise the quality of antihypertensive treatment in routine care

Aims To assess the impact of simple, collectively produced, evidence-based guidelines on optimizing the choice of antihypertensive drugs in routine care. Methods and 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 β-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. (Am Heart J 2002;144:726-32.)