Evidence map›Paper›PMID 33753350›Full record

ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2021

Impact of changes to national guidelines on hypertension-related workload: an interrupted time series analysis in English primary care.

Sarah L Lay-Flurrie, James P Sheppard, Richard J Stevens, Christian Mallen, Carl Heneghan, Fd Richard Hobbs, Bryan Williams, Jonathan Mant, Richard J McManus

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

Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
0.1field-weighted citation impact, top 45% 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

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Economic burden of cardiovascular disease in the United Kingdom.European heart journal. Quality of care & clinical outcomes · 2025
    Article
  4. Improving the Management of Hypertension by Tackling Awareness, Adherence, and Clinical Inertia: A Symposium Report.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2022
    Review
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

9 authors at 1 institution in 1 country.

Sarah L Lay-FlurrieNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
James P SheppardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Richard J StevensNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Christian MallenSchool for Primary, Community and Social Care, Keele University, Staffordshire.
Carl HeneghanNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Fd Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Bryan WilliamsNational Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, Institute of Cardiovascular Science, University College London, London.
Jonathan MantPrimary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge.
Richard J McManusNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
University of Oxford · GB

Funding

Medical Research Council MC_PC_11004Medical Research Council MC_PC_13090Wellcome Trust 211182/Z/18/Z
6 · The paper itself

Abstract

backgroundIn 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis.

aimTo assess the impact of guideline change on rates of hypertension-related consultation in general practice. DESIGN AND

settingA retrospective open cohort study in adults registered with English general practices contributing to the Clinical Practice Research Datalink between 1 April 2006 and 31 March 2017.

methodThe primary outcome was the rate of face-to-face, telephone, and home visit consultations related to hypertension with a GP or nurse. Age- and sex-standardised rates were analysed using interrupted time-series analysis.

resultsIn 3 937 191 adults (median follow-up 4.2 years) there were 12 253 836 hypertension-related consultations. The rate of hypertension-related consultation was 71.0 per 100 person-years (95% confidence interval [CI] = 67.8 to 74.2) in April 2006, which remained flat before 2011. The introduction of the NICE hypertension guideline in 2011 was associated with a change in yearly trend (change in trend -3.60 per 100 person-years, 95% CI = -5.12 to -2.09). The rate of consultation subsequently decreased to 59.2 per 100 person-years (95% CI = 56.5 to 61.8) in March 2017. These changes occurred around the time of diagnosis, and persisted when accounting for wider trends in all consultations.

conclusionHypertension-related workload has declined in the last decade, in association with guideline changes. This is due to changes in workload at the time of diagnosis, rather than reductions in misdiagnosis.

Indexed as

HypertensionWorkloadAdultCohort StudiesHumansInterrupted Time Series AnalysisPrimary Health CareRetrospective Studiesblood pressureconsultationgeneral practiceguidelinehypertensionworkload

Identifiers

PMID33753350
PMCPMC7997675
OpenAlexW3094269998

What Socratic 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 Socratic graph.