pressures of less than 140/90 mmHg from a baseline of 25% in 1994–1995 to 46% in 2000 (Jha et al 2003). Although not in place long enough to be evaluated by Jha et al (2003), the use of clinical reminders generated by the VA electronic medical record may have additional benefits for blood pressure control. Conclusions The need for physicians to remain up-to-date regarding improvements in medication use , procedures, and diagnostics is obviously important. Yet, there is a serious gap between current knowledge of the treatment of cardiac conditions derived from evidence-based medicine and the widespread application of this knowledge. Evidence from VA suggests that there are methods to improve the prescribing of medication, including academic detailing and the promotion of system-wide performance measures. It is not known if changes in antihypertensive medication use in VA are also occurring in non-VA settings. However, it appears that thiazide diuretics continue to be underutilized in hypertensive treatment. The recent publication of results from The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), which noted that thiazide diuretics were superior to calcium antagonists and ACE inhibitors in several areas, underscores this concern (The ALLHAT 2002). ALLHAT study findings, now incorporated into the JNC-7 guidelines, focus the therapy of uncomplicated hypertension on thiazide diuretics (Chobanian et al 2003). Hopefully, lessons learned from the successful reengineering of the VA healthcare system will lead to a more widespread adherence to these and similar guidelines. The views expressed in the article do not necessarily represent the views of the Department of Veterans Affairs or of the United States Government. References Amsterdam EA, Laslett L, Diercks D, et al. 2002. 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