McAlister F A, Campbell N R, Zarnke K, Levine M, Graham I D
Division of General Internal Medicine, University of Alberta, Edmonton, Alta.
CMAJ. 2001 Feb 20;164(4):517-22.
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 can be identified at the level of the clinician, the patient or the practice setting; however, the shortcomings of the guidelines themselves have received little attention. In this paper, we review the hypertension guidelines that are most commonly encountered by Canadian clinicians: the "1999 Canadian Recommendations for the Management of Hypertension," "The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" in the United States and the "1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension." The key points of these guidelines are compared and the shortcomings that may impede their ability to influence practice are discussed. The main implications for future guideline developers are outlined.
临床医生接触到众多高血压治疗指南。然而，他们对这些指南的热情以及指南的影响，充其量似乎也很有限。在临床医生、患者或医疗机构层面都能发现成功实施指南的障碍；然而，指南本身的缺点却很少受到关注。在本文中，我们回顾了加拿大临床医生最常遇到的高血压治疗指南：《1999年加拿大高血压管理建议》、美国的《美国预防、检测、评估与治疗高血压联合委员会第六次报告》以及《1999年世界卫生组织-国际高血压学会高血压管理指南》。我们比较了这些指南的要点，并讨论了可能阻碍其对临床实践产生影响的缺点。最后概述了对未来指南制定者的主要启示。
