A Systematic Review of Recent Clinical Practice Guidelines on the Diagnosis, Assessment and Management of Hypertension

Abstract

BackgroundDespite the availability of clinical practice guidelines (CPGs), optimal hypertension control is not achieved in many parts of the world; one of the challenges is the volume of guidelines on this topic and their variable quality. To systematically review the quality, methodology, and consistency of recommendations of recently-developed national CPGs on the diagnosis, assessment and the management of hypertension.Methodology/Principal FindingsMEDLINE, EMBASE, guidelines' websites and Google were searched for CPGs written in English on the general management of hypertension in any clinical setting published between January 2006 and September 2011. Four raters independently appraised each CPG using the AGREE-II instrument and 2 reviewers independently extracted the data. Conflicts were resolved by discussion or the involvement of an additional reviewer. Eleven CPGs were identified. The overall quality ranged from 2.5 to 6 out of 7 on the AGREE-II tool. 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). None of them clearly reported being newly developed or adapted. Only one reported having a patient representative in its development team. Systematic reviews were not consistently used and only 2 up-to-date Cochrane reviews were cited. Two CPGs graded some recommendations and related that to levels (but not quality) of evidence. The CPGs' recommendations on assessment and non-pharmacological management were fairly consistent. Guidelines varied in the selection of first-line treatment, adjustment of therapy and drug combinations. Important specific aspects of care (e.g. resistant hypertension) were ignored by 6/11 CPGs. The CPGs varied in methodological quality, suggesting that their implementation might not result in less variation of care or in better health-related outcomes.Conclusions/SignificanceMore efforts are needed to promote the realistic approach of localization or local adaptation of existing high-quality CPGs to the national context.

Therapeutic drug monitoring of benznidazole and nifurtimox: a systematic review and quality assessment of published clinical practice guidelines

“…The remaining three domains of scope and purpose, stakeholder involvement and clarity of presentation of the guidelines received high scores. These results are similar to a recent review of 11 reviews of CPGs of hypertension, which showed that the domains, rigour of development, applicability, and editorial independence scored consistently low across the CPGs 23 .…”

“…Discrepancies were resolved by discussion. The AGREE II instrument, which consists of 23 items, grouped into six quality domains: 1) Scope and purpose (items 1-3); 2) Stakeholder involvement (items 4-6); 3) Rigour of development (items 7-14); 4) Clarity of presentation (items 15-17); 5) Applicability (items 18-21) and 6) Editorial independence (items [22][23]. Each item was scored on a scale of 1-7, with 1 being strongly disagree, and 7 being strongly agree.…”

Psychological Intervention to Address Hypertension in South Africa’s Peri-Urban Settlements

“…There is sufficient evidence to support the critical need for health promotion and lifestyle modification interventions in addressing the high prevalence of hypertension in peri-urban areas in South Africa (Al-Ansary et al, 2013;Mungai-Singh, 2012). However, despite the higher tendency of urban black African dwellers to seek medical attention, research shows that adherence to behavioural interventions, such as dietary regimes, is in decline (King, Mainous, Carnemolla, & Everett, 2009;Marks, Murrary, Evans, & Estacio, 2011, van der Hoeven, Kruger, & Greef, 2012.…”

“…Consequently, implementing a more balanced and nutritious diet is essential for the prevention and mitigation of hypertension in South African communities (Appel et al, 1997). Despite the lack of improved national hypertension developed clinical practice guidelines (Al-Ansary et al, 2013), improved health-related outcomes for individuals with hypertension can still be achieved in these peri-urban communities. This article aims to highlight the utility of using psychological intervention techniques, namely motivational interviewing (MI) and cognitive behavioural therapy (CBT), to develop effective and culturally salient interventions to reduce the prevalence of hypertension in peri-urban areas of South Africa.…”

Uloga pola i endotela u relaksantnom efektu pinacidila na izolovanim krvnim sudovima normotenzivnih i spontano hipertenzivnih pacova

“…Hipertenzija predstavlja veliki medicinski problem današnjice sa prevalencom od 40 % među osobama starijim od 25 godina [1]. Pored velikog broja antihipertenziva i razvijene svijesti da kontrola hipertenzije dovodi do smanjenja komplikacija ove bolesti i troškova liječenja, procjenjuje se da prevalenca rezistentne hipertenzije iznosi između 20% i 30% [2].…”