Georg G, Colombet I, Durieux P, Ménard J, Meneton P
Centre des Cordeliers, INSERM U 872, Paris, France.
J Hum Hypertens. 2008 Dec;22(12):829-37. doi: 10.1038/jhh.2008.99. Epub 2008 Aug 7.
We compared the structure and content of guidelines for hypertension management across countries to gain an understanding of where differences between them originate from. Four guidelines published between 2003 and 2006 were selected. Two were issued by national agencies in the United Kingdom and France, and two were issued by working groups or national medical societies in the United States and in Europe. The structure of guidelines, the content of each section and their underlying bibliographic references were compared between authoring bodies. If differences were found between guidelines in terms of content, we analysed the rationales. The guidelines were sufficiently similar in structure, showing common sections such as lifestyle interventions, cardiovascular risk assessment and drug therapies. However, contentwise, major differences were observed across the four hypertension guidelines in virtually every section of the document. The definition of hypertension was consistent, whereas the grade stratification was not. Information concerning the blood pressure self-measurement, the estimation of cardiovascular risk and the antihypertensive drugs proposed for initial treatment also varied. Most of the differences were present in both guidelines and their rationales, but some were only found in the guidelines. The bibliographic references for the rationales differed significantly, with only 1.2, 2.2 and 8.8% of the total number of references were common to four, three and two authoring bodies, accounting for the variability. We conclude that improving the selection process of bibliographic references and the extraction process of guidelines from the rationales might be the first step to harmonize guidelines' development.
我们比较了各国高血压管理指南的结构和内容，以了解它们之间的差异源自何处。我们选取了2003年至2006年间发布的四份指南。其中两份由英国和法国的国家机构发布，另外两份由美国和欧洲的工作组或国家医学协会发布。我们对各编写机构的指南结构、各章节内容及其参考文献进行了比较。如果指南在内容方面存在差异，我们就分析其基本原理。这些指南在结构上足够相似，都有生活方式干预、心血管风险评估和药物治疗等共同章节。然而，在内容方面，这四份高血压指南在文件的几乎每个章节都存在重大差异。高血压的定义是一致的，但分级分层不一致。关于血压自我测量、心血管风险评估以及推荐用于初始治疗的降压药物的信息也各不相同。大多数差异在指南及其基本原理中都存在，但有些差异仅在指南中出现。基本原理的参考文献差异很大，四个、三个和两个编写机构的参考文献总数中分别只有1.2%、2.2%和8.8%是相同的，这导致了差异的存在。我们得出结论，改进参考文献的选择过程以及从基本原理中提取指南的过程可能是协调指南制定的第一步。
