The paper focuses on the clinical guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. The guideline was created through the collaboration between the American College of Cardiology (ACC) and American Heart Association (AHA) and other professional bodies. Several clinical questions about hypertension management in adults are addressed in the guideline including the effectiveness of ambulatory and self-directed blood pressure (BP) monitoring system; a proper period for beginning antihypertensive treatment; optimal BP target for antihypertensive therapy; harms and benefits of various antihypertensive drugs. The guideline was completed through the use of systematic literature reviews on relevant articles connected to the topic. As a result, the guideline provides critical information required for the development of effective hypertension management strategies for hypertensive patients. The main recommendations in the guideline include BP classification, new BP measurement methods, nonpharmacologic interventions, selection of effective antihypertensive drug therapy, and how to improve hypertension management. The guideline’s recommendations were developed through the systematic evaluation of the knowledge available on the topic. The credibility, clinical significance, and applicability of the guideline influence its adoption to the current situation.
Credibility
There is adequate evidence proving the credibility of the clinical hypertension guideline. Foremost, the guideline was created by an expert panel comprising of many stakeholders with a wide range of knowledge in hypertension management practices (Whelton et al., 2018). Secondly, there is the use of high-quality reviews because all the articles were peer-reviewed and carefully selected through the use of keywords; therefore, they provided relevant information in the guideline. Also, it is essential to note that the current guideline is quite current as it was prepared in 2017, and it incorporates the latest clinical evidence on hypertension up to the year 2016 (Shekelle, Aronson, & Melin, 2017). Moreover, all the recommendations in the guideline are supported by rich clinical evidence found in the articles incorporated in the review (Campbell, 2017). From the guideline’s organization, it is possible to trace back the recommendations to the specific text. Therefore, all the suggestions are credible.
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Clinical Significance
The clinical significance of the guideline cannot be underestimated. The recommendations include all the essential elements, like population description, risks, and quality supporting evidence (Murad, 2017). The recommendations are beneficial as their implementation will significantly improve hypertension management. Additionally, the risk factors associated with each recommendation are comprehensively discussed and summarized in tables; for example, the guideline outlines the medications likely to cause elevated blood pressure. Also, the guideline was reviewed by 38 independent reviewers with an objective view before its final approval and publishing. Therefore, the guideline can be used to improve clinical outcomes.
Applicability
Lastly, it is essential to consider the clinical applicability of the guideline through the evaluation of several variables. The guideline focuses on controlling hypertension among adults to reduce their vulnerability to other cardiovascular diseases (Whelton et al., 2018). Noteworthy, the research involves patients found in similar settings by highlighting the processes that should be followed to improve care quality in hospitals. Implementation of the clinical guideline will bring about changes in the pharmacy departments due to the differences in the prescription of antihypertensive medicine. The implementation of the guideline will require training patients on out of office BP monitoring to ensure the collection of accurate data. The success of the new protocol will be measured with the changes in the number of BP cases reported and treated in the hospital.
Conclusion
The recommendations in the guideline are applicable in the current situation. The guideline answers all the major questions relating to hypertension control among adults including but not limited to the use of antihypertensive drugs, BP monitoring, and appropriate interventions. Based on these recommendations, a clinical protocol will be developed through a systematic process, including a description of the objectives, methodology, and statistical implications. The protocol will then be used in the management of all hypertension cases.
References
Campbell, J. M. (2017). Quality of systematic reviews is poor, our fault, our responsibility.
Murad, M. H. (2017, March). Clinical practice guidelines: a primer on development and dissemination. In Mayo Clinic Proceedings (Vol. 92, No. 3, pp. 423-433). Elsevier.
Shekelle, P., Aronson, M. D., & Melin, J. A. (2017). Overview of clinical practice guidelines. UpToDate .
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., ... & MacLaughlin, E. J. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology , 71 (19), e127-e248.
APPENDIX A:
Appraisal Guide: Recommendations of a Clinical Practice Guideline
Brown, S. J. (2018). Evidence-Based Nursing: The research practice connection . Philadelphia,
PA: Lippincott Williams & Wilkins.
Guideline’s Citation:
Introduction - SECTION HEADER
Introduce the title of the guideline:
What group or groups produced the guideline?
What does the guideline address? Clinical questions, conditions, interventions?
What population of patients does the guideline address?
Did the panel use existing SRs or did it conduct its own?
What clinical outcomes was the guideline designed to achieve?
What are the main recommendations?
What system was used to grade the recommendations?
Credibility – SECTION HEADER
| Was the panel made up of people with the necessary expertise? | ❑ Yes | ❑ No | ❑ Not clear |
| Are the goals for developing the guideline explicit and clear? | ❑ Yes | ❑ No | ❑ Not clear |
| *Does the guideline production process include all the widely recognized steps? | ❑ Yes | ❑ No | ❑ Not clear |
| *Were the SRs used of high quality? | ❑ Yes | ❑ No | ❑ Not clear |
| Are differences in evidence for subpopulations recognized? | ❑ Yes | ❑ No | ❑ Not clear |
| *Is the evidence supporting each recommendation graded or stated as adequate to strong? | ❑ Yes | ❑ No | ❑ Not clear |
| Is the guideline current? (based on issue date and date of most recent evidence included) | ❑ Yes | ❑ No | ❑ Not clear |
| ARE THE RECOMMENDATIONS CREDIBLE? | ❑ Yes All | ❑ Yes Some | ❑ No |
Clinical Significance – SECTION HEADER
| Are essential elements of any recommended action or intervention clearly stated? | ❑ Yes | ❑ No | ❑ Not clear |
| *Is the magnitude of benefit associated with each recommendation clinically important? | ❑ Yes | ❑ No | ❑ Not clear |
| *Is the panel’s certainty or confidence in each recommendation clear? | ❑ Yes | ❑ No | ❑ Not clear |
| Were patient concerns, values, and risks addressed? | ❑ Yes | ❑ No | ❑ Not clear |
| Were downsides or costs of each recommendation addressed? | ❑ Yes | ❑ No | ❑ Not clear |
| Was the guideline reviewed by outside experts and a member of the public or field tested? | ❑ Yes | ❑ No | ❑ Not clear |
| ARE THE RECOMMENDATIONS CLINICALLY SIGNIFICANT? | ❑ Yes All | ❑ Yes Some | ❑ No |
Applicability – SECTION HEADER
| Does the guideline address a problem, weakness, or decision we are examining in our setting? | ❑ Yes | ❑ No | Specify: |
| Did the research evidence involve patients similar to ours, and was the setting similar to ours? | ❑ Yes | ❑ No | ❑ Some |
| What changes, additions, training, or purchases would be needed to implement and sustain a clinical protocol based on these conclusions? | Specify. Train patients on out of office BP monitoring | ||
| *Is what we will have to do to implement the new protocol realistically achievable by us (resources, capability, commitment)? | ❑ Yes | ❑ No | ❑ Not clear |
| Which departments and/or providers will be affected by a change? | Specify. Pharmacy department | ||
| *How will we know if our patients are benefiting from our new protocol? | Specify. Measuring number of BP cases | ||
| Conclusion – SECTION HEADER | |||
| ARE THE RECOMMENDATIONS APPLICABLE TO OUR SITUATION? | ❑ Yes All | ❑ Yes Some | ❑ No |
| SHOULD WE PROCEED TO DESIGN A PROTOCOL BASED ON THESE RECOMMENDATIONS? | ❑ Implement ALL | ❑ Implement SOME | ❑ No |
