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Commentary |

National Guidelines, Clinical Trials, and Quality of Evidence

Bruce M. Psaty, MD, PhD; Curt D. Furberg, MD, PhD; Marco Pahor, MD; Michael Alderman, MD; Lewis H. Kuller, MD, DrPH
Arch Intern Med. 2000;160(17):2577-2580. doi:10.1001/archinte.160.17.2577.
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THE RESULTS of clinical trials provide the best evidence for clinical decision making and public policy. Since the publication of a meta-analysis showing the benefits of low-dose diuretic therapy for the treatment of hypertension,1 several new clinical trials have been published, and their results are being incorporated into the new guidelines for hypertension. Both the British and American hypertension guidelines2,3 recommend not only low-dose diuretics but also dihydropyridine calcium channel blockers for older adults with isolated systolic hypertension on the basis of the results of the Systolic Hypertension in Europe Trial (Syst-Eur Trial).4 In the new British Hypertension Society guidelines for hypertension management,2 the authors rely on evidence from the Hypertension Optimal Treatment randomized trial (HOT)5 to define treatment goals. Moser's6 review of the national recommendations for the pharmacologic treatment of hypertension considers the recently published Captopril Prevention Project (CAPPP) randomized trial.7

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