Evidence map›Paper›PMID 30185571›Full record

ArticleBMJ open2018

Association of guideline and policy changes with incidence of lifestyle advice and treatment for uncomplicated mild hypertension in primary care: a longitudinal cohort study in the Clinical Practice Research Datalink.

James P Sheppard, Sarah Stevens, Richard J Stevens, Jonathan Mant, Una Martin, F D Richard Hobbs, Richard J McManus

Abstract read
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In one paragraph

Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Lifestyle advice for hypertension or diabetes: trend analysis from 2002 to 2017 in England.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022
    Article
  6. Article
  7. Diagnosis and management of hypertension in adults: NICE guideline update 2019.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

James P SheppardUniversity of Oxford, Oxford, UK.ORCID 0000-0002-4461-8756
Sarah StevensUniversity of Oxford, Oxford, UK.ORCID 0000-0003-1094-8455
Richard J StevensUniversity of Oxford, Oxford, UK.ORCID 0000-0002-9258-4060
Jonathan MantUniversity of Cambridge, Cambridge, UK.
Una MartinUniversity of Birmingham, Birmingham, UK.
F D Richard HobbsUniversity of Oxford, Oxford, UK.
Richard J McManusUniversity of Oxford, Oxford, UK.ORCID 0000-0003-3638-028X

Funding

Department of Health 12/01/52Department of Health IS-SPC-0514-10043Department of Health NIHR-RP-02-12-015Medical Research Council MR/K022032/1
6 · The paper itself

Abstract

objectivesEvidence to support initiation of pharmacological treatment in patients with uncomplicated (low risk) mild hypertension is inconclusive. As such, clinical guidelines are contradictory and healthcare policy has changed regularly. The aim of this study was to determine the incidence of lifestyle advice and drug therapy in this population and whether secular trends were associated with policy changes.

designLongitudinal cohort study.

settingPrimary care practices contributing to the Clinical Practice Research Datalink in England.

participantsData were extracted from the linked electronic health records of patients aged 18-74 years, with stage 1 hypertension (blood pressure between 140/90 and 159/99 mm Hg), no cardiovascular disease (CVD) risk factors and no treatment, from 1998 to 2015. Patients exited if follow-up records became unavailable, they progressed to stage 2 hypertension, developed a CVD risk factor or received lifestyle advice/treatment. PRIMARY OUTCOME MEASURES: The association between policy changes and incidence of lifestyle advice or treatment, examined using an interrupted time-series analysis.

resultsA total of 108 843 patients were defined as having uncomplicated mild hypertension (mean age 51.9±12.9 years, 60.0% female). Patientsspent a median 2.6 years (IQR 0.9-5.5) in the study, after which 12.2% (95% CI 12.0% to 12.4%) were given lifestyle advice, 29.9% (95% CI 29.7% to 30.2%) were prescribed medication and 19.4% (95% CI 19.2% to 19.6%) were given both. The introduction of the quality outcomes framework (QOF) and subsequent changes to QOF indicators were followed by significant increases in the incidence of lifestyle advice. Treatment prescriptions decreased slightly over time, but were not associated with policy changes.

conclusionsDespite secular trends that accord with UK guidance, many patients are still prescribed treatment for mild hypertension. Adequately powered studies are needed to determine if this is appropriate.

Indexed as

Practice Guidelines as TopicQuality of Health CareAdultAntihypertensive AgentsBlood PressureDirective CounselingElectronic Health RecordsEnglandFemaleHealth PolicyHumansHypertensionInterrupted Time Series AnalysisLife StyleLongitudinal StudiesMaleAntihypertensive Agentsblood pressurecardiovascular disease preventionelectronic health recordsgeneral practiceinterrupted time series

Identifiers

PMID30185571
PMCPMC6129091

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.