Appraisal of Five Clinical Guidelines for the Management of Hypertension in Andean Countries and Europe

Juan Moreira, Edison Jaramillo, Mariella Anselmi, Roberto Sempertegui, Patricia Ortiz, Maria Belen Mena, Gianni Tognoni

Centro de Epidemiología Comunitaria y Medicina Tropical, Esmeraldas, Ecuador.
Department of Community Health, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador.
Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
Fundación Salud Ambiente y Desarrollo, Quito, Ecuador.

DOI: 10.4236/wjcd.2014.45028                

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.

Keywords

Hypertension, Clinical Practice Guidelines, Andean Countries, Chronic Non-Communicable Diseases

Conflicts of Interest

The authors declare no conflicts of interest.

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