The management of hypertension in Canada: a review of current guidelines, their shortcomings and implications for the future

CLINICIANS ARE EXPOSED to numerous hypertension guidelines. However, their enthusiasm for these guidelines, and the impact of the guidelines, appears modest at best. Barriers to the successful implementation of a guideline ca n be identified at the level of the clinician, the patient or the practice setting; however, the shortcomings of the guidelines themselves have receiv ed little attention. In this paper, we review the hypertension guidelines t hat are most commonly encountered by Canadian clinicians: the "1999 Canadia n Recommendations for the Management of Hypertension," "The Sixth Report of the joint National Committee on Prevention, Detection, Evaluation, and Tre atment of High Blood Pressure" in the United States and the "1999 World Hea lth Organization-International Society of Hypertension Guidelines for the M anagement of Hypertension." The key points of these guidelines are compared and the shortcomings that may impede their ability to influence practice a re discussed. The main implications for future guideline developers are out lined.