东南亚临床实践指南中关于高血压管理的建议与国际知名来源的一致性。
Concordance of recommendations across clinical practice guidelines for the management of hypertension in Southeast Asia with internationally reputable sources.
机构信息
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
Department of Pharmacy, University of Huddersfield, Huddersfield, UK.
出版信息
BMC Cardiovasc Disord. 2021 Jul 28;21(1):354. doi: 10.1186/s12872-021-02054-x.
OBJECTIVES
This study aimed to assess the rate of concordance, and to investigate sources of non-concordance of recommendations in the management of hypertension across CPGs in Southeast Asia, with internationally reputable clinical practice guidelines (CPGs).
METHODS
CPGs for the management of hypertension in Southeast Asia were retrieved from the websites of the Ministry of Health or cardiovascular specialty societies of the individual countries of Southeast Asia during November to December 2020. The recommendations for the management of hypertension specified in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guideline were selected to be the reference standards; the recommendations concerning the management of hypertension in the included CPGs in Southeast Asia were assessed if they were concordant with the reference recommendations generated from both the 2017 ACC/AHA guideline and the 2018 ESC/ESH guideline, using the population (P)-intervention (I)-comparison (C) combinations approach.
RESULTS
A total of 59 reference recommendations with unique and unambiguous P-I-C specifications was generated from the 2017 ACC/AHA guideline. In addition, a total of 51 reference recommendations with unique and unambiguous P-I-C specifications was generated from the 2018 ESC/ESH guideline. Considering the six included CPGs from Southeast Asia, concordance was observed for 30 reference recommendations (50.8%) out of 59 reference recommendations generated from the 2017 ACC/AHA guideline and for 31 reference recommendations (69.8%) out of 51 reference recommendations derived from the 2018 ESC/ESH guideline.
CONCLUSIONS
Hypertension represents a significant issue that places health and economic strains in Southeast Asia and demands guideline-based care, yet CPGs in Southeast Asia have a high rate of non-concordance with internationally reputable CPGs. Concordant recommendations could perhaps be considered a standard of care for hypertension management in the Southeast Asia region.
目的
本研究旨在评估东南亚临床实践指南（CPG）中高血压管理建议的一致性，并探讨其与国际知名临床实践指南（CPG）之间不一致的原因。
方法
2020 年 11 月至 12 月期间，从东南亚各国卫生部或心血管专业学会的网站上检索了东南亚高血压管理的 CPG。选择 2017 年美国心脏病学会（ACC）/美国心脏协会（AHA）指南和 2018 年欧洲心脏病学会（ESC）/欧洲高血压学会（ESH）指南中规定的高血压管理建议作为参考标准；评估纳入的东南亚 CPG 中高血压管理的建议是否与从 2017 年 ACC/AHA 指南和 2018 年 ESC/ESH 指南生成的参考建议一致，使用人群（P）-干预（I）-比较（C）组合方法。
结果
从 2017 年 ACC/AHA 指南中总共生成了 59 条具有独特且明确的 P-I-C 特征的参考建议。此外，从 2018 年 ESC/ESH 指南中总共生成了 51 条具有独特且明确的 P-I-C 特征的参考建议。考虑到来自东南亚的 6 份 CPG，从 2017 年 ACC/AHA 指南中生成的 59 条参考建议中有 30 条（50.8%），从 2018 年 ESC/ESH 指南中生成的 51 条参考建议中有 31 条（69.8%）是一致的。
结论
高血压在东南亚地区对健康和经济造成了重大压力，需要基于指南的治疗，但东南亚的 CPG 与国际知名 CPG 之间存在高度不一致性。一致的建议或许可以被视为东南亚地区高血压管理的标准。
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