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Adoption in China of Clinical Practice Guidelines for hypertension using Traditional Chinese Medical approaches: a literature review based on clinical studies.

BACKGROUND
Increasing Clinical Practice Guidelines (CPGs) of Traditional Chinese Medicine (TCM) have been developed in China, and it is not clear about the real application in the clinical studies. This study aimed to analyze the adoption of CPGs for hypertension using TCM therapy by investigating the clinical research literature on representative CPGs for TCM in China.


METHODS
All CPGs on TCM for hypertension were collected and investigated from all of the clinical research literature published in China from January 2005 to December 2010. Ten (10) CPGs on TCM for hypertension were searched and analyzed, collecting data about the issuing organization, date of publication, classification, characteristics, contents, and citation rates.


RESULTS
By the end of December 2008, 10 CPGs on TCM for hypertension were found. Of these guidelines, one was a Chinese national standard, one was a local authority standard, two were professional administration standard, and six were academic association standards. Furthermore, four were compiled under the title of hypertension based on TCM syndrome differentiation and six were only compiled under the title of a TCM syndrome. Of all the research articles (n=695), TCM CPGs were cited in 417 articles (60%). TCM CPGs on hypertension were commonly used as standards for diagnosis and/or outcome measurements. Three hundred and seventy-nine (379) clinical research articles were unclear or inconsistent in their adoption of TCM CPG, accounting for 55% of all clinical articles. Seven (7) categories of inconsistent or unclear citations of TCM CPG were identified, and the total amount of occurrences of seven categories on inconsistent citation was 572.


CONCLUSIONS
About 60% publications cited the CPGs for their clinical research, and most of them cited in an inconsistent and unclear way. According to the result, better training of TCM practitioners and improvement of CPG development and adoption are needed.