Treatment of hypertension in Spanish primary care centres: is it evidence based?

One of the problems with medical prescriptions is that the evidence upon which many professional decisions are made is scarce and poor. In this sense there are numerous forms of prevention diagnostics and therapeutics performed by physicians indifferent clinical environments. Furthermore, over recent years, the development of new drugs has accelerated, and the control of multiple risk factors, including cholesterol, has become a critical factor in preventing primary and secondary coronary events. Despite the compelling evidence of the benefits of statin therapy, many surveys carried out over the past decade to monitor both diagnosis and treatment of the risk factors involved have revealed that a wide gap in treatment exists during the implementation of evidence-based medicine. The purpose of the World Health Organization Drug Utilization Research Group-Spain (DURG-E) is to secure advances in drug utilization research. However, such efforts remain insufficient, mainly due to the little interest shown by the healthcare services in applying suitable methods to evaluate both new procedures and those already established in the healthcare system. Physician surveys and practice audits have shown that the approach to the diagnosis, investigation and treatment of hypertension differs not only among geographic areas, but also among physicians in one given geographic area, and also with the course of time. This variation may have a detrimental effect on the effectiveness and efficiency of care. Various data have been published about the proportion of medical practice that is evidencebased medicine: 82% according to Ellis (of which 53% is based on clinical trials and 29% on nonexperimental studies), 21%, 15%, and 25.4 and 41.8% (based on clinical trials and non-experimental studies, respectively). From all the consultations made during visits to primary care physicians in Spain, and in other countries, the diagnosis of hypertension is the most common. The way in which physicians treat hypertension affects both hypertension control Public Health (2004) 118, 594–598