New hypertension guidance risks overdiagnosis and overtreatment

Haase, Christoffer Bjerre; Gyuricza, János Valery; Brodersen, John

doi:10.1136/bmj.l1657

Cited by 18 publications

(14 citation statements)

References 9 publications

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“…Gudelines have evolved from defining hypertension with a few measures to including more specific diagnostic tools, such as home blood pressure monitoring for longer periods of time [9]. However, guidelines have tended to lower hypertension definitions [10], besides the lack of evidence to do so [11].…”

Section: Introductionmentioning

confidence: 99%

Development of an item pool for a questionnaire on the psychosocial consequences of hypertension labelling

Gyuricza

d’Oliveira

Machado

et al. 2019

J Patient Rep Outcomes

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Background: Hypertension is the most prevalent risk factor for cardiovascular disease globally. Roughly one-third of the adult population has hypertension. However, most people diagnosed with hypertension do not benefit from blood pressure control with pharmacologic interventions: they are overdiagnosed and overtreated and might experience negative psychosocial consequences of being labelled. These consequences are relevant outcomes that need to be assessed and validly measured to identify all benefits and harms related to interventions designed to prevent cardiovascular disease. Objectives: To develop a pool of items with high content validity for a draft version of a condition-specific questionnaire to measure the psychosocial consequences of being labelled with mild hypertension. Methods: We selected relevant items from existing Consequences of Screening (COS) questionnaires. These items belonged to two groups: COS core items and potential condition-specific items. All items were originally in Danish and were translated into Brazilian Portuguese using the dual-panel method. Individual and group interviews were conducted with people with mild hypertension and low risk for cardiovascular disease, and were designed to test the translated items for face and content validity and were also used to generate new relevant items. Structured individual interviews were conducted to categorise all the items into domains. Results: The Brazilian Portuguese dual-panel translation of both groups of items was found to be relevant for adults diagnosed with hypertension. We generated 52 new items to achieve high content validity. The result was a set of 132 items divided into 22 domains in 2 parts. Part I was directed at the general population, whereas part II was directed only at people diagnosed with hypertension and it consisted of 38 items in 8 domains. Twelve items remained as single items. High content validity was achieved with the pool of 132 items divided into 22 domains in 2 parts. Discussion: High content validity was achieved for a condition-specific questionnaire measuring the psychosocial consequences of being labelled with mild hypertension. This instrument encompassed 132 items divided into 22 domains in 2 parts. Thereby, a draft of the Consequneces of Hypertension questionnaire (COH) was developed. The psychometric properties of this questionnaire will be discussed in a diferent paper.

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Section: Introductionmentioning

confidence: 99%

Development of an item pool for a questionnaire on the psychosocial consequences of hypertension labelling

Gyuricza

d’Oliveira

Machado

et al. 2019

J Patient Rep Outcomes

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“…21 Presently, there is widespread criticism that current medicine perpetuates the problem of over-testing and overdiagnosis, calling for studies and guidelines to adopt a more holistic people-centred approach that takes these challenges into account. 18,48,49 In order to navigate the challenge of maximising utility but minimising burden of AKI, rigorous RAM was used with representation from secondary and primary care. This included recruitment through the RCGP overdiagnosis working group.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Guidance for post-discharge care following acute kidney injury: an appropriateness ratings evaluation

et al. 2020

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BackgroundAcute kidney injury (AKI) is associated with poor health outcomes, including increased mortality and rehospitalisation. National policy and patient safety drivers have targeted AKI as an example to ensure safer transitions of care.AimTo establish guidance to promote high-quality transitions of care for adults following episodes of illness complicated by AKI.Design & settingAn appropriateness ratings evaluation was undertaken using the RAND/UCLA Appropriateness Method (RAM). The Royal College of General Practitioners (RCGP) AKI working group developed a range of clinical scenarios to help identify the necessary steps to be taken following discharge of a patient from secondary care into primary care in the UK.MethodA 10-person expert panel was convened to rate 819 clinical scenarios, testing the most appropriate time and action following hospital discharge. Specifically, the scenarios focused on determining the appropriateness and urgency for planning: an initial medication review; monitoring of kidney function; and assessment for albuminuria.ResultsTaking no action (that is, no medication review; no kidney monitoring; or no albuminuria testing) was rated inappropriate in all cases. In most scenarios, there was consensus that both the initial medication review and kidney function monitoring should take place within 1–2 weeks or 1 month, depending on clinical context. However, patients with heart failure and poor kidney recovery were rated to require expedited review. There was consensus that assessment for albuminuria should take place at 3 months after discharge following AKI.ConclusionSystems to support tailored and timely post-AKI discharge care are required, especially in high-risk populations, such as people with heart failure.

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“…An editorial published in The BMJ raised concerns about the potential harms of lowering the treatment threshold, including adverse drug reactions, psychological harms, and overtreatment 4…”

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confidence: 99%

NICE lowers treatment threshold for high blood pressure

Mahase¹

2019

BMJ

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New hypertension guidance risks overdiagnosis and overtreatment

Abstract: The boundaries of disease should be defined by multidisciplinary panels, including patients

Cited by 18 publications

References 9 publications

Development of an item pool for a questionnaire on the psychosocial consequences of hypertension labelling

Development of an item pool for a questionnaire on the psychosocial consequences of hypertension labelling

Guidance for post-discharge care following acute kidney injury: an appropriateness ratings evaluation

NICE lowers treatment threshold for high blood pressure

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