We appreciate Dr Vasandani's interest in our article. Although it is possible that physicians' behavior has changed dramatically since our survey after the release of JNC VI1 in 1997 as Dr Vasandani states, historical evidence makes this profoundly unlikely. It has been documented thatJNC III and JNC V had limited effect on physicians' behavior, and we suspect that physicians were less encumbered by guidelines than they are now.2,3 Ongoing monitoring of hypertension control in our own health care system (which serves more than 60 000 patients with hypertension and historically has had control levels similar to those of other clinical samples4) indicates that there has been no change in the proportion of patients with hypertension controlled to JNC VI treatment standards since the early 1990s, even among patients with diabetes.
Hyman DJ, Pavlik V. Other Factors in Self-Reported Hypertension Treatment Practices Among Primary Care Physicians—Reply. Arch Intern Med. 2001;161(11):1458. doi: