This article examines the rationale for the differences in the guidelines for hypertension management of four national or international bodies : the Joint National Committee (JNC-V), The World Health Organization/International Society of Hypertension (WHO-ISH), the British Hypertension Society (BHS), and the New Zealand guidelines.
These guidelines agree on many aspects of management, but differ on two very important points-the drugs of first choice for hypertension, and the indications for drug treatment of uncomplicated mild hypertension.
JNC-V recommends treatment routinely of all people with a sustained blood pressure of 140/90 mm Hg, whereas the BHS guidelines advise treatment routinely at 160/100 mm Hg.
Such differences in the threshold for treatment have a major impact on the proportion of the adult population to be treated, and on the benefit from treatment.
JNC-V was heavily influenced by the Hypertension Detection and Follow-up Program (HDFP), which appeared to show a large benefit from the treatment of uncomplicated mild hypertension, whereas the BHS guidelines were influenced by the Medical Research Council (MRC) Trial, which showed a very small benefit.
However, the apparent differences in absolute benefit between these, and other, randomized controlled trials is related entirely to differences in the absolute cardiovascular risk of the populations studied. (...)
Mots-clés Pascal : Hypertension artérielle, Antihypertenseur, Chimiothérapie, Pression artérielle, Hémodynamique, Cardiopathie coronaire, Analyse coût efficacité, Economie santé, Nouvelle Zélande, Océanie, Traitement, Facteur risque, Evaluation, Homme, Appareil circulatoire pathologie
Mots-clés Pascal anglais : Hypertension, Antihypertensive agent, Chemotherapy, Arterial pressure, Hemodynamics, Coronary heart disease, Cost efficiency analysis, Health economy, New Zealand, Oceania, Treatment, Risk factor, Evaluation, Human, Cardiovascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0468580
Code Inist : 002B02F05. Création : 19/02/1999.