Clinical Practice Guidelines for Hypertension: Evaluation of Quality Using the AGREE II Instrument

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Hypertension is an important public health challenge. The purpose of clinical practice guidelines (CPGs) is to provide explicit recommendations for clinical practice, reduce inadequate variations, optimize results, minimize risks, and promote cost-effective practice. Therefore, a highly methodological quality development process for CPGs is more likely to yield a CPG that contains relevant and appropriate recommendations.


To assess the quality of CPGs for the prevention and treatment of hypertension, a systematic search was performed using the following literature databases: PubMed, Excerpta Medica Database (EMBASE), Web of Science, the National Guideline Clearinghouse (NGC), Chinese National Knowledge Infrastructure (CNKI), Wan fang Data, VIP, and Chinese Biomedical Literature Database (CBM). Then the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument was used to assess the quality of the CPGs.


Forty-one CPGs were identified (ten CPGs in Chinese and 31 CPGs in English). The results for the overall recommendation were as follows: strongly recommended (15 %), recommended (29 %), weakly recommended (51 %), and not recommended (5 %). The scores for all domains (mean ± standard deviations) were “scope and purpose” (58.65 ± 12.67 %), “stakeholder involvement” (48.07 ± 11.41 %), “rigor of development” (27.31 ± 12.29 %), “clarity of presentation” (53.89 ± 11.09 %), “applicability” (40.10 ± 13.33 %), and “editorial independence” (38.75 ± 16.43 %). All differences were statistically insignificant for all domains (P > 0.05) according to publication time. CPGs using an evidence-based (EB) method were of a higher quality than non-EBs for all domains, but the differences were significant for the following domains: “Scope and Purpose,” “Rigor of Development,” “Applicability,” and “Editorial Independence” (P < 0.05). The scores for the CPGs developed based on associations and society appeared slightly higher than those developed by individuals. However, the differences were insignificant for all domains (P > 0.05).


A more systematic approach for the development and report of these guidelines is recommended. The AGREE II instrument can be a useful tool to improve the quality of guidelines.

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This work was supported by the West Light Foundation of The Chinese Academy of Sciences, the Natural Science Foundation of Gansu Province (Funding NO.1501RJZA003) and the Science Projects of Lanzhou City (Funding NO.2015-2-51).

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Correspondence to Jing Yu.

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Xiaowei Zhang, Kun Zhao, Zhenggang Bai, Jing Yu, and Feng Bai declare that they have no conflict of interest that might be relevant to the contents of this manuscript.

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Zhang, X., Zhao, K., Bai, Z. et al. Clinical Practice Guidelines for Hypertension: Evaluation of Quality Using the AGREE II Instrument. Am J Cardiovasc Drugs 16, 439–451 (2016) doi:10.1007/s40256-016-0183-2

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  • Standard Deviation
  • Domain Score
  • Stakeholder Involvement
  • Chinese National Knowledge Infrastructure
  • Editorial Independence