Evidence map›Paper›PMID 32649727›Full record

ArticlePloS one2020

Managing hypertension in frail oldest-old-The role of guideline use by general practitioners from 29 countries.

Céline Roulet, Zsofia Rozsnyai, Katharina Tabea Jungo, Milly A van der Ploeg, Carmen Floriani, Donata Kurpas, Shlomo Vinker, Sanda Kreitmayer Pestic, Ferdinando Petrazzuoli, Kathryn Hoffmann and 11 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
0.6field-weighted citation impact, top 29% of its field
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, 2 syntheses or guidelines pooled it, 11 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Observational
  6. Article
  7. Article
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

21 authors at 15 institutions in 12 countries.

Céline RouletInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Zsofia RozsnyaiInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Katharina Tabea JungoInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Milly A van der PloegDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Carmen FlorianiInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Donata KurpasFamily Medicine Department, Wroclaw Medical University, Wroclaw, Poland.
Shlomo VinkerSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sanda Kreitmayer PesticFamily Medicine Department, University of Tuzla, Tuzla, Bosnia and Herzegovina.
Ferdinando PetrazzuoliDepartment of Clinical Sciences, Center for Primary Health Care Research, Lund University, Malmö, Sweden.ORCID 0000-0003-1058-492X
Kathryn HoffmannDepartment of General Practice and Family Medicine, Medical University of Vienna, Vienna, Austria.
Rita P A ViegasDepartment of Family Medicine, NOVA Medical School, Lisbon, Portugal.
Christian MallenPrimary Care and Health Sciences, Keele University, Newcastle, United Kingdom.
Athina TatsioniResearch Unit for General Medicine and Primary Health Care, University of Ioannina, Ioannina, Greece.
Hubert MaisonneuvePrimary Care Unit, University of Geneva, Geneva, Switzerland.
Claire CollinsIrish College of General Practitioners, Dublin, Ireland.
Heidrun LingnerCenter for Public Health and Healthcare, Hannover Medical School, Hannover, Germany.
Rosy TsopraINSERM, Research center in Information Science to Support Personalized Medicine, University Paris Descartes and University Sorbonne Paris Cité, Paris, France.
Yolanda MuellerDepartment of Family Medicine, Center for primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Rosalinde K E PoortvlietDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Jacobijn GusseklooDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Sven StreitInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.ORCID 0000-0002-3813-4616
University of Bern · CHLeiden University Medical Center · NLCentre universitaire de médecine générale et santé publique, Lausanne · CHDélégation Paris 5 · FRKeele University · GBLeiden University · NLLund University · SEMedical University of Vienna · ATMedizinische Hochschule Hannover · DETel Aviv University · ILUniversidade Nova de Lisboa · PTUniversity of Geneva · CHUniversity of Ioannina · GRUniversity of Tuzla · BAWroclaw Medical University · PL

Funding

Department of Health RP-2014-04-026
6 · The paper itself

Abstract

backgroundThe best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old. DESIGN/

settingCross-sectional study among currently active GPs from 29 countries using a case-vignettes survey.

methodsGPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries.

resultsOverall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used.

conclusionMany GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.

Indexed as

Frail ElderlyPractice Guidelines as TopicAgedAged, 80 and overBlood PressureClinical Decision-MakingGeneral PractitionersHumansHypertension

Identifiers

PMID32649727
PMCPMC7351187
OpenAlexW3041527825

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.