| Clinical healthcare example | GPG maintenance scenario | |
---|---|---|---|
Target condition |  | Arterial hypertension is absent (< 140/90 mmHg) | The recommendation is not outdated (There was no new peer-reviewed scientific evidence published) |
Staging | Staging variable | Magnitude of pressure on artery walls in a free-living setting | Practice variation |
Staging test | Ambulatory blood pressure monitoring | Data registry analysis | |
Staging test protocol | The patient receives a blood pressure measuring device to wear over the course of 24Â h. The device is programmed to record the blood pressure each 30Â min. Blood pressure measurements are averaged for daytime and nighttime | Data from registries are obtained. Variables concerning the CPG recommendation are analyzed in statistical software to show whether there are deviations from the recommendation in clinical practice | |
Staging test thresholds | Optimal: < 120 mmHg systolic and/or < 80 mmHg diastolic arterial pressure Normal: 120–129 mmHg systolic and/or 80–84 mmHg diastolic arterial pressure High normal: 130–139 mmHg systolic and/or 85–89 mmHg diastolic arterial pressure | Neglectable practice variation: No or some deviations from the recommendation are observed, however it was judged that these deviations are not of importance or that the observed deviations are not necessarily unwanted Considerable unwanted practice variation: It was judged that most of the observed deviations from the recommendation are unwanted | |
Management | Option #1, when: indications | Do not provide an intervention, when: Optimal OR normal blood pressure is present | Re-assess at a later point in time, when: Neglectable practice variation is present |
Option #2, when: indications | Advice on lifestyle changes, when: High normal blood pressure is present | Archive, when: Neglectable practice variation is present AND the clinical field signals that guidance is no longer neededa | |
Option #3, when: indications | Advice on lifestyle changes and consider drug prescription, when: High normal blood pressure is present AND very high cardiovascular risk profile especially with coronary artery disease is presenta | Update, when: Considerable unwanted practice variation is present |