Are the 1999 guidelines WHO-ISM applied in clinical practice?

The aim of the 1999 WHO-ISM guidelines is to help the physicians in the man agement of hypertensive patients. The institution of antihypertensive treat ment represents an important stage of this management sometimes at the detr iment of lifestyle measures (non pharmacological treatments). Objectives: To evaluate if the 1999 WHO-ISM guidelines concerning the initi ation of antihypertensive treatment are applied in a hypertension clinic. Methods: Seventy hypertensive subjects never treated by antihypertensive dr ugs, aged 51+/-13 years, managed in daily hospitalization, were included in the study. According to their level of cardiovascular risk, we evaluated t he concordance between the 1999 WHO-ISM guidelines and the clinical practic e in term of institution of treatment. Results: A concordance of 70% between the 1999 WHO-ISM guidelines and the c linical practice was observed (50/70 subjects) and a discordance in 30% of cases (20/70). Among the discordant subjects, the treatment was instituted in 65% of cases although it was not recommended. In contrast, in the remain ing 35% of cases, lifestyle measures have been proposed although an antihyp ertensive treatment was recommended. The principal determinants of the disc ordance were the grade 2 of hypertension, the presence of 1 or 2 risk facto rs and an enhanced cardiovascular risk (greater than or equal to 3 risk fac tors). Neither age, nor gender were an explicative parameter of the observe d discordance. Conclusions: The 1999 WHO-ISM guidelines concerning the initiation of antih ypertensive treatment are more often applied in clinical practice. However, in some cases of grade 2 hypertension drug treatment is more often prescri bed than recommended by guidelines, and not enough in the presence of numer ous cardiovascular risk factors.