Variation in hypertension clinical practice guidelines: a global comparison

In May 12, 2021, Richu Philip, et al published an article entitled “Variation in hypertension clinical practice guidelines: a global comparison” in BMC Medicine. This study systematic searched and analysed national and international hypertension clinical practice guidelines (CPGs) published between 2010 to May 2020.

High quality CPGs can aid in the effective management of patients. In the condition of hypertension, inconsistencies exist between CPGs, and the extent of this remains unknown. In this study, researchers performed a systematic search on the MEDLINE repository and finally included 48 CPGs from across all World Bank income settings for analysis. According to the results, 96% of the included CPGs defined hypertension as a clinic-based BP of 140/90 mmHg, while 87% CPGs recommended a target BP of < 140/90 mmHg. In the pharmacological treatment of hypertension, there are eight, 17 and six different recommendations for first-step, second-step and third-step drug, respectively. Low-income countries preferentially recommended diuretics (63%) in the first-step treatment, and high-income countries offered more choice between antihypertensive classes. 44% CPGs recommended initiating treatment with dual-drug therapy at BP 160/100 mmHg or higher.

This study indicated that published CPGs related to hypertension around the world remained largely consistent in the definition, staging, and target BP recommendations for hypertension, but vary widely in terms of treatment, particularly for second-line therapy. Compared with higher-income countries, low-income countries prescribed cheaper drugs, offered less clinician choice in medications and initiated dual therapy at later stages.