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Guidelines for hypertension management in primary care: is local adaptation possible?

Nathália C Leite-Santos1, Daniela O de Melo2, Rafael A Mantovani-Silva2

  • 1Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo.

Journal of Hypertension
|September 5, 2020
PubMed

Insights

High-quality hypertension clinical practice guidelines (CPGs) show agreement on most recommendations. Conflicts exist regarding blood pressure thresholds for pharmacotherapy and treatment goals, especially for low-risk and older patients.

Area of Science:

  • Cardiology
  • Clinical Practice Guidelines
  • Evidence-Based Medicine

Background:

  • Hypertension impacts over a billion individuals globally.
  • Clinical practice guidelines (CPGs) for hypertension management are debated, particularly regarding treatment thresholds.
  • Adapting CPGs locally requires high-quality guidelines with minimal recommendation conflicts.

Purpose of the Study:

  • To compare high-quality hypertension CPGs and identify conflicting recommendations.
  • To assess the quality of hypertension CPGs using AGREE II criteria.
  • To inform the adaptation of CPGs for local contexts.

Main Methods:

  • A systematic search for hypertension CPGs published between 2016-2019 was conducted.
  • High-quality CPGs were defined by AGREE II 'rigor of development' and 'editorial independence' scores ≥60%.
  • Recommendations from high-quality CPGs were compared to identify conflicts (disagreements among >2 CPGs).

Main Results:

  • Nineteen CPGs were identified; eight were rated as high-quality.
  • The AGREE II 'applicability' domain scored lowest (40.0%).
  • Conflicts were found in recommendations for initiating pharmacotherapy and setting therapeutic goals, particularly for patients with low cardiovascular risk and older adults.

Conclusions:

  • High-quality hypertension CPGs with substantial agreement exist, facilitating local adaptation.
  • Guideline developers can focus on adapting and implementing consistent recommendations.
  • Addressing specific areas of conflict can improve guideline utility.
Abstract

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