Hypertension guidelines, meta-analyses and clinical trials: Do we assume too much?.

Abstract

* Given fundamental differences in the recommendations in guidelines from major national and international committees, we cannot rely on them unquestioningly. * Different antihypertensive agents are known to have differing effects according to age and race. * Exchanging (rather than following guideline recommendations of adding to) an ineffective first-line antihypertensive drug can result in control of hypertension with monotherapy. * Conclusions about a preferable first-line antihypertensive agent are limited by trial protocols with varying drug doses and questionable drug combinations. * Guidelines are often based on meta-analyses of drugs of a particular class, which could ignore important differences between drugs within a class. * Trials of 3-5 years cannot determine the long-term effects of drugs which patients often take for decades.