SY 01-1 ADAPTATION OF MAJOR GUIDELINES FOR REGIONAL APPLICATIONS

Clinical practice guidelines, which are systematically developed statements aimed at helping people make clinical, policy-related and system-related decisions, frequently vary widely in quality. A strategy is needed to differentiate among guidelines and ensure that those of the highest quality are implemented. Hypertension Canada provides annually updated standardized recommendations and clinical practice guidelines to detect, treat and control hypertension. The annual, evidence-based recommendations are developed through intense discussion of the clinical implications via a systematic review of the literature followed by critical appraisals of all the new clinical research, taking into account the assessment criteria in the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument that evaluates the process of practice guideline development and the quality of reporting. Systematic methods are used to search for evidence with criteria for selecting the evidence that are clearly described. The strengths and limitations of the body of evidence and the methods for formulating the recommendations are also clearly described. There is an explicit link between the recommendations and the supporting evidence. At the International Society of Hypertension we believed that there was a need to provide a simple guideline that could be followed in any healthcare system, from developed to middle and low income countries. We tried to produce a brief set of evidence and expert opinion-based recommendations, useful not only for primary care physicians and medical students, but for all professionals who work as hands-on practitioners. It has to be recognized that it will often not be possible to carry out all suggestions for clinical evaluation, tests, and therapies. Indeed, in healthcare systems of very low resources, the most simple and empirical care for hypertension – simply distributing whatever antihypertensive drugs might be available to people with high blood pressure – is better than doing nothing. If maintaining intensive control of BP requires very frequent follow-up and increased medication, in low and middle-income countries where cardiovascular drugs are not all present in the list of national essential medicines, where access to physicians or other healthcare professionals is limited, and where advanced BP measurement such as automated BP devices are unavailable, it is unlikely that it will be possible to follow the same recommendations as in wealthier countries. Lowering of BP should be carried out therefore adapting knowledge to regional possibilities and evidence. However, in most jurisdictions an attempt should be made to lower blood pressure of most hypertensive patients below 140/90 mmHg and in high cardiovascular risk subjects if possible below 130/80 mmHg as tolerated, with the available medications in the particular healthcare system, in order to improve outcomes of hypertensive patients.

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