Quality of meta-analyses for randomized trials in the field of hypertension: a systematic review.
Publication/Presentation Date
12-1-2016
Abstract
OBJECTIVES: Doubling on average every 6 years, hypertension-related meta-analyses are now published twice weekly and are often considered the highest level of evidence for clinical practice. However, some hypertension specialists and guideline authors view meta-analyses with skepticism. This article evaluates the quality of hypertension-related meta-analyses of clinical trials.
METHODS: A systematic search was conducted for meta-analyses of clinical trials recently published over 3.3 years. Specific criteria reproducibly assessed 26 features in the four domains of meta-analysis quality, domains justified by fundamental analytics and extensive research: analyzing trial quality, analyzing heterogeneity, analyzing publication bias, and providing transparency.
RESULTS: A total of 143 meta-analyses were identified. A total of 44% had 8+ deficient features with no relation to journal impact factor: odds ratio relating 8+ deficient features to the upper third versus lower third of impact factor = 1.3 (95% confidence limit 0.6-2.9). A total of 56% had all four domains deficient. Quality did not improve over time. Thirty articles (21%) reported statistically significant results (P < 0.05) from inappropriate DerSimonian-Laird models, whereas unreported, appropriate, Knapp-Hartung models gave statistical nonsignificance; 88% of these 30 articles reported the incorrect results in their abstracts. A total of 60% of all meta-analyses failed to conduct analyses in subgroups of quality when indicated, 63% failed to report Tau and Tau, 57% omitted testing for publication bias, none conducted a cumulative analysis for publication bias, and 71-77% omitted mentioning in their abstracts problems of trial quality, heterogeneity, and publication bias.
CONCLUSION: Although widespread, deficiencies in hypertension-related meta-analyses are readily corrected and do not represent flaws inherent in the meta-analytic method.
Volume
34
Issue
12
First Page
2305
Last Page
2317
ISSN
1473-5598
Published In/Presented At
Roush, G. C., Amante, B., Singh, T., Ayele, H., Araoye, M., Yang, D., Kostis, W. J., Elliott, W. J., Kostis, J. B., & Berlin, J. A. (2016). Quality of meta-analyses for randomized trials in the field of hypertension: a systematic review. Journal of hypertension, 34(12), 2305–2317. https://doi.org/10.1097/HJH.0000000000001094
Disciplines
Medicine and Health Sciences
PubMedID
27755384
Department(s)
Department of Medicine
Document Type
Article