Hypertension Guidelines: The Time

is Now

Dr. Mzee Ngunga

Interventional cardiologist

Aga Khan University Hospital, Nairobi

Kenya

We actually have guidelines

MOH and

WHO

We actually have guidelines

4 pages long: A good

cook book

So Why Change?

History

Do Clinical Guidelines Change Practice?Improve Patient Outcomes?

STRIVETM

Performance Matters!Association Between Hospital Guideline

Adherence and In-hospital Mortality in CRUSADE

Adapted with permission from Peterson ED, et al. JAMA.2006;295:1912-1920.

NSTE ACS = non-ST-segment elevation ACS; NSTEMI = non-ST-segment elevation MI.

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7

6

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2

1

01 2 3 4

In-H

os

pit

al M

ort

ali

ty,

%

Hospital Composite Guideline

Adherence Quartiles

NSTE ACS 8

7

6

5

4

3

2

1

01 2 3 4

In-H

os

pit

al M

ort

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%Hospital Composite Guideline

Adherence Quartiles

NSTEMI

CRUSADE = Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse

Outcomes With Early Implementation of the ACC/AHA Guidelines.

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GAP Initiative: Changes in Mortality Before and After GAP Project

Eagle KA, et al. J Am Coll Cardiol. 2005;46:1242-1248.

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5

10

15

20

25

30

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In-hospital

Mortality

30-d

Mortality

1-yr

Mortality

% Baseline

Post-GAP P=.017

P=.001

P=.004

Guidelines Applied in

Practice (GAP)

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Why in Kenya?

Improve care delivery

Decentralize Care

Get all doctors –

involved – Specialist to

medical officer of

health

Cost effective

Efficiency

Open opportunities

Guideline making process

• Campaign – Referendum!

• All stakeholders

- doctors

- pharmaceutical

- patients

- hospitals

- insurance companies NO

Campaign

KAP, KCS, Universities, MOH etc

Doctors

Magazines

All other mass media

What Makes a Good Clinical

Guideline?

The Guidelines

Systematically developed

Based on best available evidence

Promote effective and efficient

healthcare

Reduces variations in practice

that may be undesirable or

unacceptable

Utilize different practitioners and

professionals during their

development.

What Consists Hypertension Guidelines?

1. Statement of purpose

2. The Scope

3. Elements

- Screening

- Prevention

- Measurements ? What machine? Service?

- Diagnosis

- Tests – What?

- Documentation – National register, like TB

- Follow up

4. Evaluation

Penn

“In the midst of every challenge

lies opportunity”

-Albert Einstein

STRIVETM

Hypertension Guidelines

Where is the Evidence?

Screening, Prevention, Medication, Dose, Tests, Follow up

Tests

What tests? Does it change management? How often? Who should order what?

Follow up?

How often, What about if patients gets ACS, Heart Failure, or stroke, or CKD

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