Skip to main content
NCBI home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 1999 Mar;49(440):175–179.

A novel method of guideline development for the diagnosis and management of mild to moderate hypertension.

J L Adams 1, D A Fitzmaurice 1, C M Heath 1, R F Loudon 1, A Riaz 1, A Sterne 1, C P Thomas 1
PMCID: PMC1313367  PMID: 10343418

Abstract

BACKGROUND: There are large numbers of clinical guidelines available covering many clinical areas. However, the variable quality of their content has meant that doctors may have been offered advice that has been poorly researched or is of a conflicting nature. It has been shown that local involvement in guideline development increases the likelihood of their use. AIM: To develop a guideline to be used by general practitioners in six practices in Birmingham from existing evidence-based guidelines. METHOD: Recommendations from the four most cited international hypertension guidelines, and the more recently published New Zealand guidelines, were divided into subject areas and tabulated to facilitate direct comparison. Where there was complete or majority (> or = 3/5) agreement, the recommendation was taken as acceptable for inclusion in the new guideline. Where there was disagreement (< or = 2/5), recommendations were based on the best available evidence following a further MEDLINE literature search and critical appraisal of the relevant literature. Each recommendation was accompanied by a grade of evidence (A-D), as defined by the Canadian Hypertension Society, and an 'action required' statement of either 'must', 'should', or 'could', based on the Eli-Lilly National Clinical Audit Centre Hypertension Audit criteria. The recommendations were summarized into a guideline algorithm and a supporting document. The final format of both parts of the guideline was decided after consultation with the practice teams. The practices individually decided on methods of data collection. RESULTS: The guideline was presented as a double-sided, A4 laminated sheet and an A4 bound supporting document containing a synthesis of the original guidelines in tabular form, a table of the resulting recommendations, and appendices of current literature reviews on areas of disagreement. The content of the final Birmingham Clinical Effectiveness Group (BCEG) guideline differed minimally from any of the original guidelines. CONCLUSION: The main strength of this method of guideline development may lie, not in the actual content of the resulting guideline, but in the strength of ownership felt by the BCEG and the practices following its development. While the full process is unlikely to be possible for general practitioners working outside an academic environment, the techniques used could provide a framework for practitioners to adapt national and international guidelines for use at a local level.

Full Text

The Full Text of this article is available as a PDF (75.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Carruthers S. G., Larochelle P., Haynes R. B., Petrasovits A., Schiffrin E. L. Report of the Canadian Hypertension Society Consensus Conference: 1. Introduction. CMAJ. 1993 Aug 1;149(3):289–293. [PMC free article] [PubMed] [Google Scholar]
  2. Fahey T. P., Peters T. J. What constitutes controlled hypertension? Patient based comparison of hypertension guidelines. BMJ. 1996 Jul 13;313(7049):93–96. doi: 10.1136/bmj.313.7049.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Fardy H. J., Jeffs D. Focus groups: a method for developing consensus guidelines in general practice. Fam Pract. 1994 Sep;11(3):325–329. doi: 10.1093/fampra/11.3.325. [DOI] [PubMed] [Google Scholar]
  4. Grol R. Development of guidelines for general practice care. Br J Gen Pract. 1993 Apr;43(369):146–151. [PMC free article] [PubMed] [Google Scholar]
  5. Haines A., Feder G. Guidance on guidelines. BMJ. 1992 Oct 3;305(6857):785–786. doi: 10.1136/bmj.305.6857.785. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Haynes R. B., Lacourcière Y., Rabkin S. W., Leenen F. H., Logan A. G., Wright N., Evans C. E. Report of the Canadian Hypertension Society Consensus Conference: 2. Diagnosis of hypertension in adults. CMAJ. 1993 Aug 15;149(4):409–418. [PMC free article] [PubMed] [Google Scholar]
  7. Jones J., Hunter D. Consensus methods for medical and health services research. BMJ. 1995 Aug 5;311(7001):376–380. doi: 10.1136/bmj.311.7001.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ogilvie R. I., Burgess E. D., Cusson J. R., Feldman R. D., Leiter L. A., Myers M. G. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of essential hypertension. CMAJ. 1993 Sep 1;149(5):575–584. [PMC free article] [PubMed] [Google Scholar]
  9. Sackett D. L. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1989 Feb;95(2 Suppl):2S–4S. [PubMed] [Google Scholar]
  10. Sever P., Beevers G., Bulpitt C., Lever A., Ramsay L., Reid J., Swales J. Management guidelines in essential hypertension: report of the second working party of the British Hypertension Society. BMJ. 1993 Apr 10;306(6883):983–987. doi: 10.1136/bmj.306.6883.983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Woolf S. H. Practice guidelines, a new reality in medicine. II. Methods of developing guidelines. Arch Intern Med. 1992 May;152(5):946–952. [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES