全球药物干预治疗高血压合并其他疾病指南的系统评价  

Global Guidelines Concerning Pharmacological Intervention for Complicated Hypertension: A Systematic Review

作　　者：陈尹[1,2] 胡世莲[2] 李幼平[1] 沈干[3] 燕伯希[4] 王莉[1] 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041 [2]安徽省立医院安徽省循证医学中心,合肥230001 [3]中共安徽省委机关医院,合肥230001 [4]四川大学华西口腔医学院,成都610041

出　　处：《中国循证医学杂志》2012年第12期1446-1462,共17页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价药物干预高血压合并不同疾病指南。方法计算机检索MEDLINE、EMbase、CBM、WanFang Data、NGC(national guideline clearinghouse)、GIN(guideline international netword)、NICE(national institute for health and clinical excellence)及中国临床指南协作网(CPGN)等中、英文数据库和指南网站,纳入药物干预高血压合并其他疾病的临床指南,采用指南评价工具(appraisal of guidelines for research and evaluation,AGREE)评价指南的方法学质量,通过同类比较,分析不同地区和质量疾病的指南对药物推荐的异同及特点。结果共纳入21篇药物干预高血压合并其他疾病的指南。其中高血压合并冠心病、卒中、糖尿病及肾病的指南分别有5、5、7及4篇,发布于2000～2011年。其中A级指南0篇,B级19篇,C级2篇和循证指南9篇。4类指南均在"制定指南的参与人员"及"适用性"2个领域的平均得分欠佳。循证指南中的证据级别和推荐强度级数的分类方法各有4和3种,表达形式各有10和6种。对高血压伴心绞痛患者,指南一致推荐β受体阻滞剂(β-blocker,BB)和CCB;对高血压伴心梗患者,指南一致推荐ACEI和BB;对高血压伴心衰患者,ACEI、血管紧张素受体拮抗剂(angiotensin-receptor blocker,ARB)及BB是指南一致推荐药物。对高血压卒中后期患者,76.47%的指南推荐D和ACEI。对急性脑卒中的血压控制,指南推荐内容主要基于美国相关专业委员会制定的指南。对高血压合并糖尿病或肾病患者,收缩压/舒张压控制范围一致推荐应分别小于130/80 mmHg。对高血压合并糖尿病患者,一致推荐ACEI,其次为D和CCB;对高血压合并肾病患者,一致推荐ACEI/ARB。5篇推荐使用CCB的指南中有3篇来自亚洲。结论高血压合并不同疾病的指南中循证指南占比较高,但方法学质量存在差异。循证指南中对证据级别和推荐强度的划分标准不一,有待进一步完善。对高血压合并冠心病、糖尿病、�Objective To systematically review the methodological quality of guidelines concerning pharmacological intervention for complicated hypertension. Methods The databases and relevant guideline websites such as MED- LINE, EMbase, CBM, WangFang Data, National Guideline Clearinghouse （NGC）, Guidelines International Network （GIN）, National institute for Health and Clinical Excellence （NICE） and Clinical Practice Guideline Network （CPGN） were searched to collect the clinical guidelines concerning pharmacological intervention for complicated hypertension. By adopting the Appraisal of Guidelines for Research and Evaluation （AGREE）, the methodological quality of guidelines was assessed. Meanwhile the similarities, differences and features of drug recommendation in guidelines for different areas and diseases were analyzed by means of analogy comparison. Results A total of 21 guidelines concerning pharmacological intervention for complicated hypertension were included. The number of guidelines concerning hypertension complicated with coronary heart disease （CHD）, stroke, diabetes mellitus （DM） and kidney disease （KD） was 5, 5, 7 and 4, respectively. The publication year ranged from 2000 to 2011. According to the AGREE instrument, 19 and 2 guidelines were graded as Level B and C, respectively. The overall guidelines got low average scores in the domain of ＂Stakeholder involvement＂ and ＂Applicability＂, including 9 evidence-based guidelines. There were totally 4 and 3 classes in terms of the level of evidence and recommendation, respectively; moreover, 10 and 6 expression forms were adopted in the level of evidence and recommendation, respectively. For hypertension with angina pectoris, -blocker （BB） and calcium channel blocker （CCB） were recommended unanimously. For hypertension with myocardial infarction, angiotensin converting enzyme inhibitor （ACEI） and BB were recommended unanimously. For hypertension with heart failure, ACEI, angiotensin-receptor blocker （ARB） and BB

关 键 词：高血压合并其他疾病 冠心病 卒中 糖尿病 肾病 药物干预 指南 系统评价 

分 类 号：R544.1[医药卫生—心血管疾病]