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Editorial |

Why the Slow Diffusion of Treatment Guidelines Into Clinical Practice?

Theodore A. Kotchen, MD
Arch Intern Med. 2007;167(22):2394-2395. doi:10.1001/archinte.167.22.2394.
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From 1960 to 1994, the age-adjusted mortality rates for stroke and coronary heart disease declined by 60% and 53%, respectively. Cardiovascular mortality has continued to decline since 1994, although at a less steep rate. A number of factors have contributed to these favorable trends, including a better understanding of the risks of “benign” hypertension and the increased availability of effective antihypertensive agents. In clinical trials, antihypertensive therapy has been associated with 35% to 40% reductions in stroke incidence, 20% to 25% reductions in myocardial infarction, and more than a 50% reduction in the incidence of heart failure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure1 has recommended that, as target goals, blood pressure should be lower than 140/90 mm Hg for patients receiving antihypertensive therapy and lower than 130/80 mm Hg for patients with diabetes mellitus or chronic kidney disease. To achieve these goals, most patients with hypertension will require 2 or more antihypertensive agents.

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