Document Type : Original Article
Authors
1 Institute of Cardiology and Sports Medicine, German Sport University, Cologne, Germany
2 Uzbonn GmbH – Gesellschaft für Empirische Sozialforschung und Evaluation, Bonn, Germany
Abstract
INTRODUCTION: The principal objective of clinical guidelines is to improve the quality of medical
care. However, standardized evaluation of the adoption into daily practice is missing. The aim of our
study was to investigate the implementation of guideline recommendations on the management of
arterial hypertension (AH) in German general practitioner’s (GPs) offices.
METHODS: A questionnaire focusing on the implementation of the German guidelines for the
management of AH was developed and prospectively rolled out in 3.200 GPs and field‑based
specialists in internal medicine in Germany. Data were interpreted in an explorative way.
RESULTS: Data from 689 German physicians that participated in the survey were analyzed.
Effectiveness of lifestyle changes in the management of AH was rated as very high or high in 36.6%.
When lifestyle changes only will not normalize blood pressure (BP), medical treatment will be initiated
after 2–6 months by majority of physicians. Decision for mono‑ or combination therapy was driven
by BP and patient’s risk profile. Choice for a specific antihypertensive substance was based on the
recommendations of scientific guidelines in the majority of GPs.
CONCLUSIONS: Medication treatment algorithms recommended in 2015 by German guidelines
are well accepted by GPs. Lifestyle changes are voted by only slightly more than one‑third as a
reasonable tool for the management of AH in the setting of the medical office. This might reflect a
lack of certified medical education regarding this topic. Our study was not designed to register the
time from publication of guidelines to practical implementation.
Keywords
Ochodo E, et al. Guide to clinical practice guidelines: The current
state of play. Int J Qual Health Care 2016;28:122‑8.
2. Kotchen TA. Developing hypertension guidelines: An evolving
process. Am J Hypertens 2014;27:765‑72.
3. Kahl K. Hypertonie: Leitfaden für patienten mit bluthochdruck.
Dtsch Arztebl 2017;114:A‑1657.
4. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M,
Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021‑104.
5. Brownson RC, Kreuter MW, Arrington BA, True WR. Translating
scientific discoveries into public health action: How can
schools of public health move us forward? Public Health Rep
2006;121:97‑103.
6. Anderson JG, Casebeer LL, Kristofco RE, Carillo AS. Using
Web‑Enabled Technology to Promote the Adoption of Practice
Guidelines; 2000. In: Book: Managing Healthcare Information
Systems With WEB‑Enabled Technologies. PA, USA: IGI
Publishing Hershey; 2000.
7. Mancia G, FagardR, Narkiewicz K, Redón J, Zanchetti A, Böhm M,
et al. 2013 ESH/ESC guidelines for the management of arterial
hypertension: The task force for the management of arterial
hypertension of the European society of hypertension (ESH)
and of the European society of cardiology (ESC). J Hypertens
2013;31:1281‑357.
8. Guidelines fort he management of arterial hypertension (Leitlinien
zum Management der Arteriellen Hypertonie). Hrsg: Deutsche
Gesellschaft für Kardiologie – Herz und Kreislaufforschung e.V.
und Deutsche Hochhdruckliga e.V., Börm Bruckmeier Velag
mbH; 2014
9. Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination
therapy versus monotherapy in reducing blood pressure:
Meta‑analysis on 11,000 participants from 42 trials. Am J Med
2009;122:290‑300.
10. Semlitsch T, Blank WA, Kopp IB, Siering U, Siebenhofer A.
Evaluating guidelines: A review of key quality criteria. Dtsch
Arztebl Int 2015;112:471‑8.
11. Spallek H, Song M, Polk DE, Bekhuis T, Frantsve‑Hawley J,
Aravamudhan K. Barriers to implementing evidence‑based
clinical guidelines: A survey of early adopters. J Evid Based Dent
Pract 2010;10:195‑206.