Clinical Practice Guideline on Management of Hypertension 2008 (3rd edition)

Rationale and Process of Guideline Development

Rationale

The Clinical Practice Guideline on the Management of Hypertension was developed to provide a clear and concise approach to all health care providers on the current concepts in the management of hypertension. Since hypertension is managed by various levels of health care providers in Malaysia, attempts were made to ensure the different stakeholders will benefit from this CPG. This is reflected by the representation of the committee members which developed the guideline.

There were two previous guidelines on hypertension; in 1998 and 2002. This edition is the third in the series and was deemed necessary due to new evidence which has emerged since the last edition. Prior to the publication of this edition, the Third National Health and Morbidity Survey was completed and the results have since been made available. The results of the survey showed that the prevalence of hypertension has increased with very little difference in awareness rate and rate of blood pressure control in the hypertensive population. The rate of blood pressure control remained poor despite an increase in the prevalence of diagnosed patients who were prescribed antihypertensive medication. This may reflect the fact that clinicians are still not clear of the target blood pressure to achieve in their patients while on treatment. It is hoped that this CPG will contribute towards reversing this worrying trend.

Process

The current edition of the CPG was initiated by the Malaysian Society of Hypertension. The guideline was developed in 2006/2007. A committee was convened, comprising four nephrologists, 4 cardiologists, 2 family physicians, 2 obstetrician/gynaecologists, an endocrinologist, a general physician/clinical pharmacologist, a paediatrician, an epidemiologist and a pharmacist (pharmacoeconomist). The involvement of a pharmacist (an expert in pharmacoeconomy) and an epidemiologist is unique, making this CPG more comprehensive in terms of committee membership. Besides being experts in their own fields, some of the members hold important positions in relevant non-governmental organizations and government agencies dealing with hypertension.

The development of this guideline adheres closely to the methodology outlined in the Guidelines for Clinical Practice Guideline 2003 by the Medical Development Division of the Ministry of Health. All attempts were made to ensure references quoted were current and relevant to the issues discussed. Whenever clinical recommendations were made, the best available evidence was used to support the recommendations.

The guideline was posted on both the Ministry of Health Malaysia and Academy of Medicine, Malaysia websites for comment and feedback. This guideline has also been presented to the Technical Advisory Committee for Clinical Practice Guidelines, and the Health Technology Assessment and Clinical Practice Guidelines Council, Ministry of Health Malaysia for review and approval.

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