Target Blood Pressure in HTN

Zhelnov P. A critical appraisal of ‘Arguedas JA, Leiva V, Wright JM. Blood pressure targets in adults with hypertension. Cochrane Database Syst Rev. 2020 Dec 17;12:CD004349. doi: 10.1002/14651858.CD004349.pub3. PMID: 33332584’. Zheln. 2020 Dec 19;51(2):r51d17. URI: https://zheln.com/record/2020/12/17/51/.

Zheln Review Appraisal in 10 Steps:

1. ✅ Downloaded from the PubMed Systematic Subset Daily Updates
2. ✅ Meets Shojania & Bero 2001 True Positive Criteria for Systematic Reviews by Abstract
3. ✅ Full Text & Other Reports Collected by Zheln
4. ✅ Generates Pragmatic Evidence Directly Relevant to Evidence-Based Practice
5. ✅ Not Found Duplicate by Zheln
6. 🔄 Passed or Failed Replication?
7. 🔄 Has Critical Conduct Flaws?
8. 🔄 Liked or Disliked by Zheln?
9. 🔄 Practical Implications Summarized by Zheln
10. 🔄 Appraisal Published & Call for Crowdfunding

Executive Summary

Background

I first learned about this review from Twitter. Then I posted about it on my health-educational resources in Russian (Telegram, Instagram, VK). Also, I asked the subscribers if they wanted an extensive appraisal. As of Dec 19 @ 5am EST, there were 7/9 votes for and 2/9 votes against the extensive appraisal.

Full Text & Other Reports Collected by Zheln

Successfully collected all three versions of this publication: the current 2020 paper, the outdated 2009 paper, and the 2003 protocol.

Generates Pragmatic Evidence Directly Relevant to Evidence-Based Practice?

All-cause mortality, cardiovascular mortality (CV), and rates of myocardial infarction (MI) and stroke are of interest. Most of them (save CV mortality) are featured in the review, so yes, it does in theory generate pragmatic practice-relevant evidence.

Is Duplicate?

Google: systematic review target blood pressure

Some of the top results:

• Sakima 2019 – full text collected. Not referenced by Arguedas et al., although the research question of Sakima et al. is identical to that of Arguedas et al. Also, of note, this review was first published online on Apr 5, 2019, whereas the searches were conducted on May 28–29, 2019, during the index review conduct.
• Reboussin 2018 — successfully collected the full text with a correction. One of the review questions is exactly the same as in the review by Arguedas et al. However, this review is not referenced by the authors of the index review; at the same time, the associated guideline document by Whelton et al. is referenced.

These two are important reviews targeting practically the same population, interventions, and outcomes, and they were not referenced by the original authors. Therefore, I first made an assessment that this review was duplicate.

However, I felt like another look at the review report was warranted because it is just so hard to presume such ignorance, and found a section discussing previous research. There, several methodological differences between this review and the previous ones were stated, and I found that these differences were also a thing with respect to the two aforementioned reviews. Namely, both Reboussin 2018 and Sakima 2019 interpret interventions as more or less intensive, whereas Arguedas et al. look at specific blood pressure (BP) targets. There possibly are more differences, but I believe this is already enough to disprove my previous reservations about the index review duplication.

The index review is an update of the previous 2009 review, so it is also worth looking at the reasons for the update, but that’s plain enough because 7 more eligible studies were identified in addition to the 4 earlier trials.

Thus, all in all, I don’t see that the review is importantly duplicate.

Passed or Failed Replication?

• Verbatim search strategies for all major databases searched are available. This facilitates replication.
• The search process is not reported in detail; namely, no information is provided regarding the number of references retrieved from each search and details are available as to how these references were merged.
• At the same time, I do not have access to all the databases the authors searched (e.g., Embase, ProQuest, Web of Science, etc.).
• Therefore, I fail to definitely replicate the initial set of records.
• At the same time, I do have access to Scopus whose coverage is somewhat similar to that of Embase.
• From the other hand, I do not have access to Ovid, so will need to translate the search strategies. This is usually done inexactly.
• Will use Medline Transpose for the MEDLINE searches and manual translation using the official Ovid Embase field guide for the Embase searches.

I have already started appraisal of this article and will likely complete it within a couple of days. Please return soon or follow the progress of this page here or on GitHub as I do the appraisal. Also, you can look for similar systematic review appraisals using search or by tapping on AMA specialty tags at the bottom of this page or in the side menu.

This project is independent research and is supported by crowdfunding only, so please consider making a minimal donation as low as $1 either on Patreon, GitHub Sponsors, Open Collective, or via PayPal.

By all means, you are always welcome reaching out to me for whatever reason by email or on Twitter, Facebook, Instagram, or Telegram. I’m happy to get your feedback!