nice - hypertension

Download NICE - Hypertension

Post on 27-Oct-2014

49 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

Update of clinical guidelines 18 and 34

HypertensionThe clinical management of primary hypertension in adults

Clinical Guideline 127Methods, evidence, and recommendations

August 2011

Commissioned by the National Institute for Health and Clinical Excellence

Hypertension (partial update) Contents

Published by the National Clinical Guideline Centre at The Royal College of Physicians, 11 St Andrews Place, Regents Park, London, NW1 4BT First published 2004, republished 2006 National Clinical Guideline Centre - 2011 Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use. The rights of National Clinical Guideline Centre to be identified as Author of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988.

Hypertension (partial update) Contents

ContentsRationale for update .................................................................................................................... 7 Guideline development group members ....................................................................................... 8 Acknowledgments ....................................................................................................................... 9 Acronyms and abbreviations .......................................................................................................10 1 2 Introduction ........................................................................................................................12 Development of the guideline ..............................................................................................14 2.1 2.2 2.3 2.4 2.5 3 What is a NICE clinical guideline? ....................................................................................... 14 Who developed this guideline? .......................................................................................... 15 What this guideline covers .................................................................................................. 15 What this guideline does not cover .................................................................................... 15 Relationships between the guideline and other NICE guidance ......................................... 16 2.5.1 3.1 3.2 Related guidance ................................................................................................. 16

2011 Methods .....................................................................................................................17 Developing the review questions and outcomes................................................................ 17 Searching for evidence ........................................................................................................ 17 3.2.1 3.2.2 3.2.3 3.2.4 3.2.5 3.2.6 3.2.7 3.2.8 3.2.9 3.2.10 3.2.11 3.2.12 3.3 3.3.1 3.3.2 3.3.3 3.4 3.4.1 3.4.2 3.4.3 3.4.4 Clinical literature search ...................................................................................... 17 Health economic literature search ...................................................................... 18 Evidence of effectiveness .................................................................................... 18 Inclusion/exclusion .............................................................................................. 18 Methods of combining clinical studies ................................................................ 19 Appraising the quality of evidence by outcomes ................................................ 19 Grading the quality of clinical evidence............................................................... 20 Study limitations .................................................................................................. 21 Inconsistency ....................................................................................................... 21 Indirectness ......................................................................................................... 22 Imprecision .......................................................................................................... 22 Prognostic studies................................................................................................ 24 Literature review ................................................................................................. 25 Undertaking new health economic analysis ........................................................ 26 Cost-effectiveness criteria ................................................................................... 27 Research recommendations ................................................................................ 27 Validation process ............................................................................................... 27 Updating the guideline ........................................................................................ 28 Disclaimer ............................................................................................................ 28

Evidence of cost-effectiveness ............................................................................................ 24

Developing recommendations ............................................................................................ 27

1

Hypertension (partial update) Contents 3.4.5 4 4.1.1 4.1.2 4.1.3 4.1.4 4.2 4.2.1 4.2.2 5 5.1 5.2 5.3 5.4 6 6.1 6.2 6.3 6.4 6.5 Funding ................................................................................................................ 28 Review methods .................................................................................................. 29 Group process ...................................................................................................... 31 Evidence statements and recommendations ...................................................... 31 Costs and consequences ...................................................................................... 33 Clinical evidence .................................................................................................. 34 Cost-effectiveness evidence ................................................................................ 36

2004 Methods .....................................................................................................................29

2006 methods ..................................................................................................................... 34

Guideline summary..............................................................................................................37 Algorithms ........................................................................................................................... 37 Key priorities for implementation....................................................................................... 39 Full list of recommendations .............................................................................................. 40 Key research recommendations ......................................................................................... 45 Techniques for measuring blood pressure ......................................................................... 46 6.1.1 Manual blood pressure measurement ................................................................ 46 Cuffs .................................................................................................................................... 47 Conditions and environment .............................................................................................. 47 White Coat Hypertension.................................................................................................... 48 Blood pressure measurement devices ................................................................................ 49 6.5.1 6.5.2 6.5.3 6.6 6.7 6.8 6.9 Mercury sphygmomanometer............................................................................. 49 Aneroid sphygmomanometers ............................................................................ 49 Automated devices .............................................................................................. 49

Measuring blood pressure....................................................................................................46

Ambulatory blood pressure monitors ................................................................................. 49 Home blood pressure monitors .......................................................................................... 50 Recommendations .............................................................................................................. 50 Research recommendation ................................................................................................. 51 Predicting outcome using clinic, home and ambulatory measurements ........................... 52 7.1.1 7.1.2 7.1.3 Clinical evidence 2004 ......................................................................................... 52 Clinical evid