Systematic Review

With the rapid increase in the research conducted on health sciences, there is difficulty for researchers and clinicians to be up-to-date with the studies. Therefore, reviews that give a summary of the impact of different intervention experiments are a greatly efficient way to come up with a conclusion of what is effective and what isn't. Systematic reviews are different from the traditional kind in many ways.

According to Petticrew and Roberts (2006), the systematic type of reviews normally involve a comprehensive and in depth plan along with search approach that is presumptive, with the aim of reducing partiality by finding, assessing, and integrating all significant research on a certain subject. In most cases, systematic reviews involve a component of meta-analysis that uses statistical methods to integrate the information acquired from different research into one quantitative result or outline effect size (cited in Uman, 2011). The systematic types of reviews are usually published in educational settings.

However, there are some databases and organizations particularly meant for promoting and distributing them. For instance, Cochrane Collaboration is a highly known and regarded international non-profit-making firm that supports, promotes and distributes meta-analyses and systematic reviews on how effective health care interventions are (Uman, 2011).

Meaning and Purpose of Systematic Reviews Systematic reviewing is giving an outline of the provided evidence on a well formulated query that uses explicit and systematic ways to find, choose and thoroughly assess significant primary studies as well as extract and evaluate information acquired from the research incorporated in that particular review" (p. 5). This kind of reviewing involves prior identification of its scope (e.g.

reviewing queries and sub- queries and/or undertaking sub-group evaluations); a complete search for all relevant research; use of precise criteria to exclude or include research; incorporation of recognized standards to thoroughly assess research quality; and clear ways of extracting and incorporating research results is used. In addition, systematic review finds, assesses and incorporates all the studies available and significant to a certain review query; collates all the information on a certain subject and finds the foundation of that information.

It is also a complete report that uses clear procedures so that methods, assumptions and rationale can be examined (Cochrane.org, 2005). Issue of Concern in the Article The population of hypertensive people above the age of 24 worldwide was around 40% in the year 2008. In 2009, the overall financial burden caused by hypertension in USA was around $73.4 billion. Better management of hypertension brings about better health results.

A big systematic review including 147 experimental reports on hypertension management state that a decrease of 10 mm Hg systolic BP and 5 mm Hg diastolic has been linked with a decrease by 20% of heart problems (coronary) and by 32% in stroke within one year. In addition, hypertension management is inexpensive; medical treatment leads to better health outcomes (better adjusted life-span; QALYs) (Al-Ansary et al., 2013).

Purpose of the Paper This review was aimed at evaluating the consistency and quality of propositions of modern global and national clinical guidelines on practice of examination, evaluation and control of hypertension, as well as to find out the level at which the guidelines are detailed by those systematic reviews that are Cochrane and those that are non-Cochrane (Al-Ansary et al., 2013). Credibility of Authors The review's protocol was developed as a component of a preliminary course on meta-analysis and systematic reviews taught by Sharon E.

Straus (SES) and Andrea C. Tricco (ACT) through Li Kashing Institute of Knowledge in St. Michael's Medical Centre. Some of the results were presented through posters at Madrid in Spain, during Cochrane Colloquium 19 (October 2011). Four writers; Andrea C. Tricco, Lubna A. Al-Ansary, Ghada A. Bawazeer and Yaser A. Adi were able to get all the initial guidelines; they were accountable for the information's integrity as well as the data evaluation's accuracy (Al-Ansary et al., 2013).

Overview of the Systematic Review The review was meant to assess the consistency and quality of propositions of modern global and national guidelines on the examination, evaluation and control hypertension as well as to measure the level of comprehensiveness of the guidelines of those reviews that are Cochrane as well as those that are non-Cochrane. This review was done on the basis of a protocol and included input from professionals in high blood pressure and methods of systematic review (Al-Ansary et al., 2013).

With regard to exclusion and inclusion methods, multi-disciplinary guidelines embraced by a national provider or governmental organization linked with the examination, evaluation and control of high blood pressure were incorporated. Each population subgroup needed to be assessed to make sure the guidelines meet the requirements of people with different co-morbidities; CPGs were exclusively centred on high blood pressure among such special groups as the aged, blacks, pregnant women and people with diabetes and children or such special situations as exclusively primary care or exclusively emergency management were left out.

To make sure that most modern guidelines were incorporated, there was limited inclusion for 2006 January onwards. In addition, only those guidelines that were in English were incorporated (Al-Ansary et al., 2013). Medical text words and subject titles that were linked with guidelines and hypertension were used in searching EMBASE and MEDLINE through OVID line from 2006 January to 2011 September. Other than the search done through electronic database, there were search websites as well as Google, since the guidelines were not all indicated in databases.

Particularly, the websites that were searched were: G-I-N;www.g-i-n.net, (www.guideline.gov), (www.nhmrc.gov.au/guidelines/index.htm), (www.nice.org.uk) and (SIGN;www.sign.ac.uk). The searches for literature were conducted by an experienced expert in information (LP) (Al-Ansary et al., 2013). To ensure dependability, there was training before the process of study selection began, by randomly sampling 25 citations. There were two reviewers who autonomously screened the results of the search for inclusion by means of a relevance method form that was pre-defined.

The full-text paper was acquired for possibly significant CPGs and they were then independently screened by the two reviewers. Discord that occurred at any point was dealt with through dialogue or through a third party (Al-Ansary et al., 2013). There was a rough information extraction form which was modified and piloted as required. Two independent reviewers extracted all the information by means of standardized information extraction form. The significant websites and documents from the chosen guidelines were analysed.

The extracted information included the characteristics of the CPGs such as region, country, year of distribution, funding organization and development team. It also included the recommendations with regard to the examination and evaluation of high blood pressure as well as recommendations with regard to the control of high blood pressure. The Guidelines Evaluation and Research Appraisal II technique was applied by 4 independent reviewers in the appraisal of the legitimacy of all the guidelines included.

The 4 reviewers also gave their opinion on the whole evaluation, the probable risk of partiality and suggestions for future utilization of each of the chosen guidelines that were evaluated. The list of references of each chosen CPGs was analysed and the systematic reviews, both those that were Cochrane and those that were non-Cochrane were calculated. The final search date of every CPG was looked at to find out the ready and significant reviews that had been prepared by the Cochrane High Blood Pressure Group by then.

Two independent reviewers assessed each review abstract that had been developed by Cochrane High Blood Pressure Group in order to evaluate their significance in the overall control of primary high blood pressure (Al-Ansary et al., 2013). The CPGs that were included were descriptively summarized on the basis of examination, evaluation and control suggestions.

For each of the items, we indicated whether it was CPG recommended, the evidence level (in accordance to the research design) as well as the eminence of research that supported or refuted the suggestions (determined after thorough appraisal of the research by the reviewers). For examination and evaluation, these classes were used: finding any cardiovascular risks, methods of measuring blood pressure, physical examination, medical history, subclinical destruction of an organ as well as laboratory examination.

For control, these classes used: changes in lifestyle, beginning of therapy, therapy type, therapy adjustment, combination therapy, dangers linked with therapy, special group consideration such as the elderly, pregnant women, people with diabetics or kidney dysfunction; compliance, referral to an expert and follow-up (Al-Ansary et al., 2013). All the guidelines were supportive of the same modifications of life style as the most important method of controlling hypertension. There were minor differences on the suggestions of dietary supplements, potassium consumption increase, emotional and stress control as well as exercise.

All the guidelines were insistent on the necessity to quit smoking, retaining weight, reducing consumption of sodium, following guidelines on nutrition, limiting consumption of alcohol (excluding SAU) and reducing the consumption of fat (excluding AUS) for people with hypertension. Most of the guidelines suggested using any among the 5 types of antihypertensive medication (enzyme inhibitors for angiotensin conversion, blockers of angiotensin receptions, beta-blocker diuretics or blockers of, calcium channels) as initial therapy (Al-Ansary et al., 2013).

Contribution and Outcomes Just like the results of previous evaluations of many CPGs on different cases, Al-Ansary e al. discovered that the developers of the guideline were not consistent in the use of systematic reviews. Only two modern reviews provided by the Cochrane High Blood Pressure Group were indicated in the CPGs they assessed.

This result is at par with an analysis that was recently conducted on 106 guidelines by NICE, which indicated that 20% of CPGs did not use any Cochrane citation while 40% used between one and five Cochrane reviews, even though most of them were seen to handle the guideline queries. Surprisingly, even with the increase in Cochrane reviews, current CPGs hardly used the significant reviews as reference.

The Collaborations of Cochrane should investigate why there were so little references from Cochrane reviews and come up with strategies to increase the rate of referencing from their reviews (Al-Ansary et al., 2013). The recommendations of CPGs on evaluation and non-pharmacological control were quite consistent. Guidelines were different in terms of the chosen initial treatment, therapy adjustment and medicine combinations. Significant specific care aspects such as resistant high blood pressure were left out by 6/11 guidelines.

The guidelines had differences in the quality of their methodologies, implying that their execution was not likely to bring about lower care variation or improved health results (Paperity team, 2016). Each of the CPGs has endorsed the idea of global or traditional assessment of cardiovascular risk in the stratification of treatment that is presumed to be based on evidence, yet the evidence level for this preposition was not indicated. Considering the current complaints on how the recent risk assessment methods may leave out some of the patient features, that.