Assessing the quality of guidelines for primary aldosteronism: which guidelines are worth applying in diverse settings?

OBJECTIVE: To review the validity and applicability of clinical guidelines on the management of primary aldosteronism and to list their discrepancies to allow health-care providers and guideline developers to make informed decisions.

DESIGN AND METHODS: Primary aldosteronism management guidelines, including specialist, subgroup, general guidelines written in English, were obtained from electronic databases. Appraisers independently extracted the data, and used the Appraisal Guidelines Research and Evaluation II (AGREE-II) tool and the Institute of Medicine (IOM) criteria to independently evaluate the methodological quality of the guidelines. Then, the appraisers used the Guideline Implementability Appraisal (GLIA) tool to assess the implementation of the guidelines that complied with AGREE-II and IOM. In addition, we further compared the discrepancies in the primary aldosteronism management recommendations.

RESULTS: We have identified 12 guidelines published between 2006 and 2016. Only the Endocrine Society and the Canadian Hypertension Education Program guidelines of them were of good methodological quality according the AGREE-II and IOM instrument, but with still much room for improvement. Neither of these two was rated as easily implementable according to the GLIA tool. Discrepant recommendations were identified at all management steps (screening, confirmation, classification, treatment and follow-up).

CONCLUSION: The guidelines quality was mostly poor, and the higher quality guidelines also needed improvement prior to their implementation. Meanwhile, significant differences existed in the recommendation for the same clinical problem. Therefore, future guideline development should be performed in strict accordance with the AGREE-II, IOM and GLIA criteria to improve the diagnosis and treatment of primary aldosteronism.