How you can use the evidence to improve your patients’ outcomes
The most recent edition of Heart Foundation guidelines for the management of hypertension is an evidence-based and practical guide for doctors.1 It is self-evident that clinical guidelines need to be used by doctors if they are to improve population health outcomes. Despite publication of multiple editions of the hypertension guidelines, blood pressure (BP) control in Australia is less than ideal.2 The reasons for this are varied, and include health system, doctor and patient factors.3
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- 1. National Heart Foundation of Australia (National Blood Pressure and Vascular Disease Advisory Committee). Guide to management of hypertension 2008. http://www.heartfoundation.org.au/SiteCollectionDocuments/A%20Hypert%20Guidelines2008%20Guideline.pdf (accessed Jun 2009).
- 2. Barr ELM, Magliano DJ, Zimmet PZ, et al. AusDiab 2005: the Australian Diabetes, Obesity and Lifestyle Study. Melbourne: International Diabetes Institute, 2006. http://www.diabetes.com.au/pdf/AUSDIAB_Report_Final.pdf (accessed Jun 2009).
- 3. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560-2572.
- 4. Nelson MR, Quinn S, Bowers-Ingram L, et al. Cluster-randomized controlled trial of oscillometric vs manual sphygmomanometer for blood pressure management in primary care (CRAB). Am J Hypertens 2009; 22: 598-603. doi: 10.1038/ajh.2009.55
- 5. British Hypertension Society. Validated blood pressure monitors list. http://www.bhsoc.org/blood_pressure_list.stm (accessed May 2009).
- 6. Gaborieau V, Delarche N, Gosse P. Ambulatory blood pressure monitoring versus self-measurement of blood pressure at home: correlation with target organ damage. J Hypertens 2008; 26: 1919-1927.
- 7. National Vascular Disease Prevention Alliance. Quick reference guide for health professionals: absolute cardiovascular disease risk assessment. 2009. http://www.heartfoundation.org.au/SiteCollectionDocuments/A_AR_QRG_FINAL%20FOR%20WEB.pdf (accessed Jun 2009).
- 8. Wang Z, Hoy WE. Is the Framingham coronary heart disease absolute risk function applicable to Aboriginal people? Med J Aust 2005; 182: 66-69. <MJA full text>
- 9. Peeters A, Ting J, Nelson MR, McNeil JJ. Coronary heart disease risk prediction by general practitioners in Victoria [letter]. Med J Aust 2004; 180: 252. <MJA full text>
- 10. Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2008; (2): CD000165. doi: 10.1002/14651858.CD000165.pub3.
- 11. Hansson L, Zanchetti A, Carruthers S, et al. Effects of intensive blood-pressure lowering and low dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351: 1755-1762.
- 12. Nelson MR, Reid CM, Ryan P, et al. Self-reported adherence with medication and cardiovascular disease outcomes in the Second Australian National Blood Pressure Study (ANBP2). Med J Aust 2006; 185: 487-489.
I have participated in trials funded by SmithKline Beecham, AstraZeneca, Bayer, Sanofi-Aventis, Merck Sharp and Dohme, Pfizer, Servier Laboratories and Bristol-Myers Squibb; served on advisory boards for Sanofi-Aventis, Novartis, Schering-Plough and Solvay Pharmaceuticals; prepared educational material for Servier Laboratories, AstraZeneca and Bristol-Myers Squibb; and received conference and travel support from Bayer HealthCare and Sanofi-Aventis.