Cardiovascular Journal of Africa: Vol 25 No 6 (November/December 2014)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 6, November/December 2014 AFRICA 297
An evidence-based treatment programme in Kaiser
Permanante, northern California,12 showed system-level success.
This programme resulted in an increase in blood pressure control
(44 to 80%) despite an increase in numbers of patients with
hypertension; possibly due to better and earlier detection, which
results independently in better treatment and control.
It is, however, important to recognise the necessity of
individualising treatment. This approach was best seen in the
physiologically based antihypertensive therapy as described by
Spence.13 Such management can, if successful, be included into
guidelines where appropriate.
Guidelines are an essential tool in the care of chronic diseases.
They provide a means to update and disseminate information
and the standard of care to all health sectors. However, they
are only as good as the clinicians who implement them, and the
system that provides the infrastructure for their implementation.
Furthermore, they need to be appropriate for the system in which
they will be implemented.
Erika SW Jones, MB BCh, FCP, Cert Nephrol, PhD,
Brian L Rayner, MB ChB, MMed, FCP, PhD
Hypertension Clinic, Groote Schuur Hospital, Cape Town,
South Africa
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