Complementary medicine mention and recommendations are limited across hypertension guidelines: A systematic review.

The purpose of this study was to determine the quantity of complementary medicine (CM) recommendations and their quality across clinical practice guidelines (CPGs) for the treatment and/or management of hypertension. A systematic review was conducted to identify hypertension CPGs. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018, alongside the Guidelines International Network and the National Centre for Complementary and Integrative Health websites. Eligible articles were assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. From 1445 unique search results, 18 CPGs for the treatment and/or management of hypertension published in 2008 or later were eligible for review, though only 1 contained CM recommendations. This CPG was published by the European Society of Cardiology and the European Society of Hypertension, and made a recommendation regarding the Mediterranean diet. The scaled domain percentages of this CPG overall scored significantly better than the CM section across every domain, and were as follows: (overall, CM): scope and purpose (88.9 %, 66.7 %), clarity-of-presentation (88.9 %, 0.0 %), stakeholder involvement (66.7 %, 16.7 %), applicability (60.4 %, 0.0 %), rigor-of-development (35.4 %, 15.6 %), and editorial independence (4.2 %, 0.0 %). A lack of CM treatment recommendations exists in CPGs for the treatment and/or management of hypertension. Given that it is known that a high proportion of patients with hypertension seek CM, current hypertension guidelines' lack of CM treatment and/or management recommendations reflects a large gap in guidance for both clinicians and patients.

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Declaration of Competing Interest The authors declare that they have no conflicts of interest.