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Clinical practice guidelines for hypertension in China: a systematic review of the methodological quality

Yin Chen¹, Shilian Hu², Lei Wu³

¹Anhui Evidence-based Medicine Center, Anhui Provincial Hospital, Hefei, Anhui, China.

|July 17, 2015

Insights

This systematic review found significant quality variations in Chinese hypertension clinical practice guidelines (CPGs). Methodological rigor and editorial independence require improvement for better patient care recommendations.

Area of Science:

Cardiovascular Medicine
Health Services Research
Evidence-Based Practice

Background:

Clinical practice guidelines (CPGs) are crucial for guiding medical decisions.
Concerns exist regarding the methodological quality of numerous CPGs, particularly in hypertension management.
This study focuses on CPGs developed in China.

Purpose of the Study:

To systematically review the methodological quality of hypertension CPGs developed in China.
To identify specific areas of strength and weakness in the development process of these guidelines.

Main Methods:

Systematic review of hypertension CPGs for adult patients in China.
Searched Chinese electronic databases, guideline websites, and Google Scholar.
Evaluated CPGs using the Appraisal of Guidelines, REsearch and Evaluation II (AGREE II) instrument.

Main Results:

Seventeen hypertension CPGs published between 2001 and 2011 were identified.
Significant variation in quality across AGREE II domains was observed.
'Rigor of development' (18%) and 'editorial independence' (16%) scored poorly.
'Stakeholder involvement' (28%) and 'applicability' (20%) were also weak.
'Scope and purpose' and 'clarity and presentation' scored better (median 41%).
Eight CPGs were recommended for use with modifications.

Conclusions:

Substantial improvements are needed in the methodological quality of Chinese hypertension CPGs.
Enhanced transparency in reporting conflicts of interest is essential.
Greater attention to evidence quality and recommendation grading is required during CPG development.

Read full analysis

Abstract

Objective:

Clinical practice guidelines (CPGs) provide clinicians with specific recommendations for practice, but due to the increasing number of CPGs developed by diverse organisations over the past few years, there are concerns about the quality of some CPGs. This paper proposes a systematic review of the methodological quality of the CPGs for hypertension that were developed in China.

Design:

A systematic review of CPGs for the management of hypertension in adult patients in China.

Data Resources:

Chinese electronic databases, Chinese guideline websites and Google Scholar were searched, and the reference lists of relevant publications were also screened for additional information. CPGs for the management of hypertension in adult patients were identified. The main characteristics of the CPGs were extracted, and the scaled Appraisal of Guidelines, REsearch and Evaluation II (AGREE II) domain percentages were independently evaluated by two reviewers.

Results:

A total of 17 CPGs, with publication dates ranging from 2001 to 2011, were identified. There was considerable variation in the quality of the CPGs across the AGREE II domains. Overall, the domains of 'rigor of development' and 'editorial independence' were poorly addressed, with an average score of 18% and 16%, respectively. Also less well addressed were the 'stakeholder involvement' and 'applicability' domains, for which the average domain scores were 28% and 20%, respectively. The CPGs performance was less problematic in the domains of 'scope and purpose' and 'clarity and presentation', with a median of 41% for both. After considering the domain scores, 8 CPGs could be recommended with modification for use.

Conclusions:

There is considerable room for improvement of the methodological quality of CPGs for hypertension in China. Greater efforts should to be devoted to ensure the explicit and transparent reporting of potential conflicts of interest of stakeholders, and to consider the quality of the evidence and grade recommendations in the CPG development process.

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