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[Local variability in the guidelines for hypertension screening, diagnosis and baseline assessment in 40 health
P J Saturno Hernández1, J J Antón Botella, J F Murcia Payá
1UD Medicina Preventiva y Salud Pública, Murcia. psaturno@fcu.um.es
Insights
Clinical protocols for hypertension (HT) screening, diagnosis, and baseline studies show significant variation across health centers in the Murcia Region. This inconsistency raises concerns about the reliability and validity of current HT management guidelines.
Area of Science:
- Cardiology
- Public Health
- Clinical Guidelines
Background:
- Arterial hypertension (HT) management relies on standardized clinical protocols.
- Existing protocols for HT screening, diagnosis, and baseline studies in the Murcia Region were examined.
Purpose of the Study:
- To identify and compare HT clinical protocols across health centers in the Murcia Region.
- To assess the validity and reliability of these regional HT protocols.
Main Methods:
- A structured comparative analysis of 40 clinical protocols for HT from all Murcia Region Health Centers.
- Comparison of regional protocols against national and international HT guidelines.
Main Results:
- Significant variations observed in target populations for HT screening (age ≥14 to >20 years).
- Inconsistent screening periodicity (6 months to 5 years) and diagnostic criteria for HT.
- Wide variability in baseline study recommendations, with only electrocardiograms being universally included.
- Discrepancies noted even with national/international guidelines, with limited explicit consideration of scientific evidence.
Conclusions:
- Substantial local variation exists in HT screening, diagnosis, and baseline study protocols.
- Patient diagnosis and management for HT may differ significantly based on the health center visited.
- The observed inconsistencies question the validity and reliability of current regional protocols, highlighting the need for critical review.
Background:
To identify and to compare the recommendations of the currently existing clinical protocols for arterial hypertension (HT) screening, diagnosis and baseline study in the Murcia Region, Spain, in order to assess their validity and reliability.
Material And Methods:
Structured comparative description of guidelines in Clinical Protocols for HT (n = 40) from all Health Centers in the Region. Comparative description of the Health Centers Clinical Protocols and national and international reference documents regarding HT screening, diagnosis and baseline assessment is performed.
Results:
Target population for screening ranged from aged > or = 14 years (24 centers) to > 20 (1 center). Screening procedure was not described in 3 centers and screening periodicity varied from 6 months to 5 years, with differences by age and by concurrent risk factors in some protocols. Diagnosis norms differed by age in only 11 protocols; blood pressure (BP) exams for diagnosis varied from 3 to 5 and there were 12 different HT figures for immediate diagnosis and treatment. Baseline study varied greatly; we found a total of 7 recommended items for anamnesis, 11 for physical exam, 19 for blood tests, 4 for urine tests, and 7 for other tests; only the electrocardiogram was common to all protocols. There was also some disagreement in the national and international reference guidelines whose scientific evidence was not always explicitly considered.
Conclusions:
There is a wide local variation in norms for HT screening, diagnosis, and baseline study. If the Centers follow their own protocols, the same patient may be or may not be diagnosed depending on the Center he visits; additionally, there would be big differences in the process and resources needed for HT control. This variation casts doubt on the protocols validity and reliability at regional level and underscores the need for critically reviewing the validity of existing protocols.