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Quality of systematic reviews supporting the 2017 ACC/AHA and 2018 ESC/ESH guidelines for the management of hypertension
  1. Raju Kanukula1,2,
  2. Rupasvi Dhurjati2,
  3. Kota Vidyasagar2,
  4. Nusrath Rehana2,
  5. Arun Talari2,
  6. Abdul Salam2,3,
  7. Anthony Rodgers3,4,
  8. Matthew J Page1
  1. 1Research Methodology Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2Cardiovascular, The George Institute for Global Health, Hyderabad, India
  3. 3Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  4. 4Cardiovascular Division, George Institute for Global Health, Sydney, New South Wales, Australia
  1. Correspondence to Raju Kanukula, Research Methodology Division, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC 3004, Australia; raju.kanukula{at}


Objective To assess the methodological and reporting quality of systematic reviews (SRs) that informed recommendations in the recent American and European hypertension guidelines.

Design and settings Meta-epidemiological study. We identified SRs that were cited for class I recommendations based on Level of Evidence-A in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) hypertension guidelines.

Main outcome measures Methodological and reporting quality of the SRs was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) checklist and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, respectively.

Results A total of 40 SRs was included in the analysis (28 from 2017 ACC/AHA; 22 from 2018 ESC/ESH and 10 were included in both). Based on the AMSTAR-2 assessment, only 7.5% SRs were found to be of high methodological quality, 47.5% were of moderate, each 22.5% were of low and critically low quality. Based on the PRISMA checklist assessment, a mean of 24 items (SD (2.76) were reported appropriately, and only five SRs reported all 27 items appropriately.

Conclusion Methodological and reporting quality of SRs were found to vary considerably. Lack of information on the funding source of included studies, use of a protocol, integration of risk of bias assessments while interpreting findings and reporting of excluded studies were major methodological deficiencies.

  • hypertension
  • cardiovascular diseases
  • evidence-based practice

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All the data submitted.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All the data submitted.

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  • Contributors RK and AS contributed to the conception of the study. RK contributed for conception and design, analysis and interpretation of the data, and drafting of manuscript. RK, RD, KV, NR, AT conducted the identification of studies and assessments. AS, AR and MJP reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.