A double-blind comparison of once-daily metoprolol controlled-release and atenolol in the treatment of Chinese patients with mild to moderate hypertension

Ethnic specific recommendations in clinical practice guidelines: a first exploratory comparison between guidelines from the USA, Canada, the UK, and the Netherlands

OBJECTIVES

To investigate whether clinical practice guidelines in different countries take ethnic differences between patients into consideration and to assess the scientific foundation of such ethnic specific recommendations.

DESIGN

Analysis of the primary care sections of clinical practice guidelines.

SETTING

Primary care practice guidelines for type 2 diabetes mellitus, hypertension, and asthma developed in the USA, Canada, the UK, and the Netherlands.

MAIN OUTCOME MEASURES

Enumeration of the ethnic specific information and recommendations in the guidelines, and the scientific basis and strength of this evidence.

RESULTS

Different guidelines do address ethnic differences between patients, but to a varying extent. The USA guidelines contained the most ethnic specific statements and the Dutch guidelines the least. Most ethnic specific statements were backed by scientific evidence, usually arising from descriptive studies or narrative reviews.

CONCLUSION

The attention given to ethnic differences between patients in clinical guidelines varies between countries. Guideline developers should be aware of the potential problems of ignoring differences in ethnicity.

Hypertension

The current JNC-VI criteria for diagnosis and classification of hypertension are discussed. The laboratory evaluation of both essential and secondary hypertension is examined, and recommendations are made in this regard. Finally, the complications and treatment of essential hypertension and the causes and management of resistant hypertension are discussed.