26 Nov Hypertension Guidelines Often Give Inconsistent Recommendations

MedicalResearch.com Interview with:

Dr. Alper

Brian S. Alper, MD, MSPH, FAAFP, FAMIA
Board Certifications: Family Medicine, Clinical Informatics
Founder of DynaMed
Vice President of Innovations and Evidence-Based Medicine Development
EBSCO Health 

MedicalResearch.com: What is the background for this study?

Response: We often use clinical practice guidelines as a “source of truth” for decision support for healthcare professionals and even as a standard of care for medical legal considerations.  However our experience evaluating guidelines for clinical reference support finds they are often inconsistent.  We picked one of the most common conditions managed in healthcare (ie hypertension, or high blood pressure) and sought out the top clinical practice guidelines that guide care around the world.   We systematically evaluated these guidelines against 70 specific recommendations to see how often the guidelines agreed or disagreed.

MedicalResearch.com: What are the main findings?

Response: .  We found that the guidelines clearly agreed on what should be done about a third of the time (32.4%) with consistent strong guidance.  Guidelines generally agreed in suggesting some actions but disagreed in how strong they made recommendations (eg “should do” vs. “may consider”) about one fourth of the time (26.5%).  But for four out of ten recommendations (41.2%) the guidelines disagreed, with some guidelines recommending for something while other guidelines recommended against it. 

MedicalResearch.com: What should readers take away from your report?

Response: First, one should not consider a single guideline as an absolute authority.   If you are using guidelines for a quick approach for helping support making decisions about what to do they can be very helpful.  But, if you are developing a system for supporting decision making (such as computerized support for clinical practice) or arguing about legal standards for medical practice, then we really need to pause, recognize that single guidelines are not the full view, and look at the totality of guidelines and other information for such things.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

 Response: This study establishes a method for how to systematically determine and report the consistency of guidelines for recommendations.   Future research can apply this method to other conditions.  Then we can start to explore the reasons for inconsistency and determine which of those reasons are problems that we need to learn from to improve, and which of those reasons are appropriate differences in context or values that we can learn from to individualize care.

MedicalResearch.com: Is there anything else you would like to add?

Response: We welcome collaboration with others interested in the mission to provide the most useful support for healthcare decision making.  We have no competing interests with any healthcare interventions used for the management of hypertension.  Many of the authors are employed by companies which provide information services which include providing healthcare guidance and decision support.

Citation:

Alper BS, Price A, van Zuuren EJ, et al. Consistency of Recommendations for Evaluation and Management of Hypertension. JAMA Netw Open. 2019;2(11):e1915975. doi: https://doi.org/10.1001/jamanetworkopen.2019.15975

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Last Updated on November 26, 2019 by Marie Benz MD FAAD