WJCD  Vol.4 No.5 , May 2014
Appraisal of Five Clinical Guidelines for the Management of Hypertension in Andean Countries and Europe
ABSTRACT
There is global concern on the methodological limitations, transferability and effectiveness of clinical practice guidelines (CPGs) for chronic non-communicable diseases, particularly for hypertension. Bolivia, Ecuador and Peru have regularly produced CPGs; however no formal assessment has been done on their contents, transferability and effectiveness. The past decade saw significant migration from Andean countries to Europe. Knowing how European CPGs compare with those produced in Andean countries is necessary to recommend future changes targeted to the migrant population. A systematic search of CPGs was done on indexed databases and non-indexed publications. Recognized and approved CPGs were identified by technical officers in the Ministries of Health of the respective countries. The guidelines of the European Society of hypertension and four selected CPGs from the Andean countries were assessed by two independent evaluators using the “Agree II instrument for assessing clinical practice guidelines, AGREE II Consortium, May 2009”. Comparison of the CPGs is based on the six domain scores provided by the Agree II instrument. The overall score of CPGs ranged from 1.85 to 2.94 of 6 maximum possible. The European CPG scored highest in 3 of 6 domains compared, most notably in rigor of development. Average domain scores for clarity of presentation (0.84) and scope and purpose (0.64) were highest scores for applicability (0.30). Stakeholder involvement (0.28) and rigor of development (0.17) were the lowest. The CPGs assessed appear to fail meeting the standards of quality and pertinence. They show a progressive worsening from domains declaring good intentions of being clear, to those which measure their hard aspects and implications.

Cite this paper
Moreira, J. , Jaramillo, E. , Anselmi, M. , Sempertegui, R. , Ortiz, P. , Mena, M. and Tognoni, G. (2014) Appraisal of Five Clinical Guidelines for the Management of Hypertension in Andean Countries and Europe. World Journal of Cardiovascular Diseases, 4, 211-216. doi: 10.4236/wjcd.2014.45028.
References
[1]   Dores, H., et al. (2013) Non-Obstructive Coronary Artery Disease Documented by Cardiac Computed Tomography: Discrepancy between Atherosclerotic Burden and Cardiovascular Risk. Revista Portuguesa de Cardiologia, 2551, 613-618.
http://dx.doi.org/10.1016/j.repc.2012.10.013

[2]   Foster, M., et al. (2013) Cardiovascular Risk Factor Burden, Treatment, and Control among Adults with Chronic Kidney Disease in the United States. American Heart Journal, 166, 150-156.
http://dx.doi.org/10.1016/j.ahj.2013.03.016

[3]   Cox, J., et al. (2013) A Novel Approach to Cardiovascular Health by Optimizing Risk Management (ANCHOR): Behavioural Modification in Primary Care Effectively Reduces Global Risk. Canadian Journal of Cardiology, 29, 1400-1407.
http://dx.doi.org/10.1016/j.cjca.2013.03.007

[4]   Remais, J.V., Zeng, G., Li, G., Tian, L. and Engelgau, M.M. (2013) Convergence of Non-Communicable and Infectious Diseases in Low- and Middle-Income Countries. International Journal of Epidemiology, 42, 221-227.
http://dx.doi.org/10.1093/ije/dys135

[5]   Joshi, P., Marino, M., Bhoi, A. and McCoy, N. (2012) Reducing the Burden of Cardiovascular Diseases: A Qualitative Assessment of Louisiana Health Disparities Collaboratives. Journal of Cardiovascular Disease Research, 3, 305-309.
http://dx.doi.org/10.4103/0975-3583.102711

[6]   Woolf, S.H., Grol, R., Hutchinson, A., Eccles, M. and Grimshaw, J. (1999) Clinical Guidelines: Potential Benefits, Limitations, and Harms of Clinical Guidelines. BMJ, 318, 527-530.
http://dx.doi.org/10.1136/bmj.318.7182.527

[7]   Legido-Quigley, H., Panteli, D., Car, J., Mckee, M. and Busse, R. (2013) Clinical Guidelines for Chronic Conditions in the European Union. European Observatory on Health Systems and Policies, Copenhagen.

[8]   Tricoci, P., Allen, J.M., Kramer, J.M., Califf, R.M. and Smith, S.C. (2009) Scientific Evidence Underlying the ACC/ AHA Clinical Practice Guidelines. JAMA, 301, 831-841.
http://dx.doi.org/10.1001/jama.2009.205

[9]   Daley, M., Lat, I. and Kane-Gill, S. (2013) Applicability of Guideline Recommendations Challenged in the Setting of Drug Shortages. Critical Care Medicine, 41, e143-e144.
http://dx.doi.org/10.1097/CCM.0b013e31828cecfa

[10]   Velupillai, Y.N., et al. (2008) Psychological, Social and Biological Determinants of Ill Health (pSoBid): Study Protocol of a Population-Based Study. BMC Public Health, 8, 126.
http://dx.doi.org/10.1186/1471-2458-8-126

[11]   Clark, A.M., MacIntyre, P.D. and Cruickshank, J. (2007) A Critical Realist Approach to Understanding and Evaluating Heart Health Programmes. Health (London), 11, 513-539.
http://dx.doi.org/10.1177/1363459307080876

[12]   Pais, P.S. (2006) Early Intervention and Prevention of Myocardial Infarction. Journal of Hypertension. Supplement, 24, S25-S30.

[13]   Taylor-Robinson, D., Milton, B., Lloyd-Williams, F., O’Flaherty, M. and Capewell, S., (2008) Policy-Makers’ Attitudes to Decision Support Models for Coronary Heart Disease: A Qualitative Study. Journal of Health Services Research & Policy, 13, 209-214.
http://dx.doi.org/10.1258/jhsrp.2008.008045

[14]   Bonati, M. (2010) Coordinating Resources to Assess and Improve Health Status of Migrants from Latin America.
http://www.cohemi-project.eu/

[15]   Mancia, G., et al. (2009) Reappraisal of European Guidelines on Hypertension Management: A European Society of Hypertension Task Force Document. Journal of Hypertension, 27, 2121-2158.
http://dx.doi.org/10.1097/HJH.0b013e328333146d

[16]   AGREE-Next-Steps-Consortium (2009) Appraisal of Guidelines for Research and Evaluation II. 2nd Edition, The AGREE Research Trust, Ontario.

[17]   Ministerio Salud y Deportes Bolivia (2009) Hipertension Arterial Sistemica. In Guia Clinica de Atencion Primaria y Medicina Familiar. La Paz, Bolivia, 226.

[18]   Ministerio Salud Publica Ecuador (2011) Protocolos clínicos y terapéuticos para la atención de las enfermedades crónicas no transmisibles (diabetes 1, diabetes 2, dislipidemias, hipertensión arterial), Ecuador.

[19]   Ministerio Salud Publica Peru (2005) Guía de hipertension arterial, 23.

[20]   Ruiz Mori, E., Segura Vega, L. and Rodriguez Montes-de-Oca, J. (2011) Guia de diagnóstico y tratamiento de la hipertensión arterial “de la teoría a la práctica”. Lima.

[21]   Blanco-Rivera, C., García-Caeiro, A.L. and Rey-Liste, T. (2007) Assessment of Clinical Practice Guidelines about Cataract Management. Archivos de la Sociedad Española de Oftalmología, 82, 429-435.

[22]   Houtart, F. (2011) El concepto de Sumak Kausay (Buen vivir) y su correspondencia con el bien común de la humanidad. Revista Ecuador Debate, 84, 57-76.

 
 
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