Artikel
A Systematic Review of Recent Clinical Practice Guidelines on the Diagnosis, Assessment and Management of Hypertension
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Autoren
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L. Al-Ansary
- Dept of Family and Comm Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Bahamdan's Research Chair for EBHC & Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
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A. Tricco
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
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Y. Adi
- Bahamdan's Research Chair for EBHC & Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
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G. Bawazeer
- Bahamdan's Research Chair for EBHC & Knowledge Translation, King Saud University, Riyadh, Saudi Arabia; College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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L. Perrier
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
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M. Al-Ghonaim
- Prince Salman Bin Abdulaziz Chair for Kidney Disease, King Saud University, Riyadh, Saudi Arabia
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N. Al-Yousefi
- Dept of Family and Comm Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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M. Tashkandi
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
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S. Strauss
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada; Division of Geriatrics, University of Toronto, Toronto, Canada
| Veröffentlicht: | 10. Juli 2012 |
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Gliederung
Text
Background: Despite the availability of clinical practice guidelines (CPGs), optimal control is not achieved in many parts of the world.
Objectives: To systematically review the quality, methodology and consistency of recommendations of recently-developed national CPGs on the assessment and the management of hypertension.
Methods: MEDLINE, EMBASE, guideline agency websites and Google were searched for CPGs written in English on the general management of hypertension for any practice setting published between Jan 2006–Jun 2011. Four raters independently appraised each CPG using the AGREE-II instrument and 2 reviewers independently extracted the data.
Results: Ten CPGs were identified. The overall quality ranged from 2.5 to 6 out of 7. The highest scores were for 'clarity of presentation' (44.4%–88.9%) and the lowest were for 'rigour of development' (8.3%–30% for 9 CGPs). It was not clear if they were adapted or newly developed CPGs. Two CPGs graded some recommendations and related that to levels (but not quality) of evidence. The CGPs' recommendations on assessment and non-pharmacological management were fairly consistent. They varied in the selection of first-line treatment, adjustment of therapy and drug combinations. Important specific aspects of care (such as managing resistant hypertension) were ignored by some CPGs.
Discussion: Most of the CPGs were of poor methodological quality, potentially limiting their impact on reducing the widespread variation of hypertension care and resulting in better health-related outcomes.
Implications: More efforts are needed to promote the realistic approach of localization or local adaptation of existing high-quality CPGs to the national context.
