Hypertension: inconsistency in clinical practice guidelines

  • Alper BS & al.
  • JAMA Netw Open
  • 1 Nov 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Clinical practice guidelines for assessing and managing hypertension have a “high rate of inconsistency”, according to findings from this cross-sectional study.
  • These authors say that no single source underlies areas of inconsistency among the 8 guidelines they examined.

Why this matters

  • These authors say that these guidelines are “poor proxies for a universally accepted source of truth.”
  • They say that the focus should be on classifying consistency across guidelines as a signpost for clinical practice.

Key results

  • Among the 8 guidelines evaluated:
    • 22 (32%) recommendations were consistent with each other for both strength and direction.
    • 18 (26%) were consistent for direction but not strength (e.g., when to use ambulatory BP monitoring).
    • 28 (41%) were inconsistent for direction (e.g., cutoffs for hypertension).
  • 17 of 48 (35%) recommendations considered of high importance showed inconsistency of direction.
  • Various analyses excluding recommendations with specific evidence ratings did not pinpoint a sole source of inconsistency.

Study design

  • 8 guidelines included, from the United States, Australia, Canada, Europe, the UK.
  • 71 recommendations were evaluated.
  • Funding: EBSCO Information Services.

Limitations

  • The authors had to create a method for evaluating consistency.
  • They dichotomised strength ratings.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit