The relation between methods and recommendations in clinical practice guidelines for hypertension and hyperlipidemia.
OBJECTIVE
To assess the association between methods used to develop clinical practice guidelines and the recommendations that are made.


METHODS
Systematic review of clinical practice guidelines for hypertension or hyperlipidemia.


METHODS
Two people independently appraised guideline methods by using 8 criteria and the aggressiveness of recommendations for treatment thresholds, initial drug selection, and screening.


RESULTS
We identified 33 guidelines. Only 6 fulfilled 5 or more of the 8 criteria. For 5 of the criteria, fewer than 50% of the guidelines fulfilled those criteria. There was wide variation in recommendations for treatment thresholds, drug selection, and cholesterol screening. Guidelines that did not fulfill the criteria tended to suggest more aggressive recommendations than did guidelines that met the criteria. For 6 of the 8 criteria, guidelines published by specialty societies were less likely to fulfill them compared with guidelines not published by specialty societies.


CONCLUSIONS
Guideline developers who did not use rigorous methods tended to promote intervening more aggressively for hypertension and hyperlipidemia.
Fretheim
Atle
A
Department of Health Services Research, Norwegian Directorate for Health Social Welfare, PO Box 8054 Dep, N-0031 Oslo, Norway. atle.fretheim@shdir.no
Williams
John W
JW
Oxman
Andrew D
AD
Herrin
Jeph
J
D000328:Adult; D000368:Aged; D005069:Evaluation Studies as Topic; D019317:Evidence-Based Medicine / Q000592:standards*; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006287:Health Planning Guidelines; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis / Q000188:drug therapy*; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011787:Quality of Health Care; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014768:Virginia