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The principles of updating CGs can be a complex, potentially resource intensive, and include three main steps: 1) identifying new evidence; 2) assessing if the new evidence has a potential impact on the current guideline; and 3) reviewing and modifying the guideline.
Any directional information, or cross street information should not be included.
Less attention has been paid to the review, modification and presentation of the recommendations.
This is probably due, among other reasons, to the likely assumption that it is similar to the development process.
In October 2015, changes to recommendations 1.3.5, 1.10.2 and 1.15.6 were made to reflect the need to consider local workload and resources.
These pediatric hypertension guidelines are an update to the 2004 “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.” Significant changes in these guidelines include (1) the replacement of the term “prehypertension” with the term “elevated blood pressure,” (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy.
We believe that there is a need to prioritise, promote and collaborate between international guideline development and research communities to improve and standardise the updating process.