Blood pressure (BP) is expected to have increased over time in children in most countries due to the increasing prevalence of childhood obesity worldwide. The authors conducted a systematic review of studies assessing secular trends in BP in children and adolescents. Of 1739 citations screened, the authors identified 18 studies including 2 042 470 participants examined between 1963 and 2012. Thirteen studies were conducted in high-income countries, five in middle-income countries, and none in lowincome countries. The prevalence of overweight or obesity increased in 17 studies and decreased in one study. BP decreased over time in 13 studies, increased in four, and did not change in one. These findings suggest that secular trends in BP do not mirror secular trends in overweight. This implies that other factors mitigate the effect of overweight on BP in children and adolescents. | BACKGROUND | METHODSWe conducted a systematic review following a detailed protocol and analysis plan, consistent with the meta-analysis of observational studies in epidemiology (MOOSE) guidelines for meta-analyses and systematic reviews of observational studies 25 and using methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions. 26The research consisted of the following steps: (1) systematic literature searches; (2) selection of study included; (3) data extraction; and (4) statistical analyses.
Background The best management of hypertension in frail oldest-old (�80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old. Design/Setting Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey. Methods GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs
Background The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear while lacking guidelines providing specific recommendations.Aim, Objectives To investigate guideline use in general practitioners (GPs) and if guideline use relates to different decisions when managing hypertension in frail oldest-old.Design/Setting Cross-sectional study.Methods GPs participated in a survey with case-vignettes of frail oldest-old varying in systolic blood pressure (SBP) and cardiovascular disease (CVD). GPs in Europe, Brazil, Israel and New Zealand were invited. We compared the percentage of GPs using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GP’s gender, years of experience and prevalence of oldest-old in their practice), we used a mixed-effects regression model accounting for clustering within countries.Results Overall, 2,543 GPs from 29 countries were included. About 60% reported to use guidelines. Higher guideline use was found in female (p=0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in guidelines use, ranging from 25% to 90% of the GPs. However, there was no difference in decisions about treatment hypertension in frail oldest-old patients between GPs that used or not used guidelines nor which guideline they used.Conclusion Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.
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