Table 5 Example of staging and management when the target condition is absent

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The recommendation is not outdated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 24 h. The device is programmed to record the blood pressure each 30 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 needed^a

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 present^a

Update, when:

Considerable unwanted practice variation is present