临床实践指南中家庭血压监测时间和频率的推荐意见对比分析  

Comparative Analysis of Recommendations for Timingand Frequency of Home Blood Pressure Monitoring in Clinical Practice Guidelines

作　　者：刘云兰 任梦娟 王子君 苏仁凤 罗旭飞 郭强强 余静[3] 邢爱君[4] 周晓阳[5] 陈耀龙 LIU Yunlan;REN Mengjuan;WANG Zijun;SU Renfeng;LUO Xufei;GUO Qiangqiang;YU jing;XING Aijun;ZHOU Xiaoyang;CHEN Yaolong(School of Public Health,Lanzhou University,Lanzhou 730000,China;School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China;Cardiovascular Department,Lanzhou University Second Hospital,Lanzhou 730030,China;Cardiovascular Department,KaiLuan General Hospital,Tangshan,Hebei 063001,China;Cardiovascular Department,Renmin Hospital of Wuhan University,Wuhan 430060,China;Research Unit of Evidence-based Evaluation and Guidelines,Chinese Academy of Medical Sciences,School of Basic Medical Sciences,Lanzhou University,Lanzhou 73000,China;Institute of Health Data Science,Lanzhou University,Lanzhou 730000,China;WHO Collaborating Center for Guideline Implementation and Knowledge Translation,Lanzhou 730000,China)

机构地区：[1]兰州大学公共卫生学院,兰州730000 [2]兰州大学基础医学院循证医学中心,兰州730000 [3]兰州大学附属第二医院心血管内科,兰州730030 [4]开滦总医院心血管内科,河北唐山063001 [5]武汉大学人民医院心血管内科,武汉430060 [6]中国医学科学院循证评价与指南研究创新单元兰州大学基础医学院,兰州730000 [7]兰州大学健康数据科学研究院,兰州730000 [8]世界卫生组织指南实施与知识转化合作中心,兰州730000

出　　处：《协和医学杂志》2023年第2期399-408,共10页Medical Journal of Peking Union Medical College Hospital

基　　金：中国医学科学院医学与健康科技创新工程-循证评价与指南研究创新单元(2021RU017)。

摘　　要：目的对比分析临床实践指南中家庭血压监测(home blood pressure monitoring,HBPM)时间和频率的推荐意见,以帮助临床医生遴选最佳推荐意见,同时为未来指南推荐意见的形成提供建议。方法系统检索和筛选近5年发表的高血压相关临床实践指南,提取HBPM时间和频率的推荐意见进行统计分析。结果共纳入包含HBPM时间和/或频率相关推荐意见的指南21篇,分别由16个国家或地区的机构制定。对于HBPM时间,所有指南均推荐每天进行早晚两次血压测量,早上血压测量时间为服用降压药前(94.4%,17/18)、早餐前(72.2%,13/18)和排尿后(55.6%,10/18),晚上血压测量时间为晚餐前(50.0%,8/16)、睡前(37.5%,6/16)和晚餐后2 h(6.3%,1/16)。对于HBPM频率,9篇(40.9%,9/22)指南建议就诊前1周至少连续测量3 d,其他指南则建议至少连续测量4 d(18.2%,4/22)、5 d(13.6%,3/22)或7 d(27.3%,6/22)。结论不同国家和地区的指南关于HBPM时间和频率的推荐意见存在较大差异,建议未来在形成推荐意见时应全面检索、评价和综合证据,充分考虑利弊平衡、可行性、患者偏好与价值观等因素,同时结合指南的实施环境,形成最佳推荐意见。Objective To compare and analyze the recommendations for the timing and frequency of home blood pressure monitoring(HBPM)in clinical practice guidelines to help clinicians select the best recom⁃mendations and provide suggestions for the development of recommendations in the future.Methods Clinical practice guidelines related to hypertension published in the last five years were systematically searched and screened,and the recommendations for the timing and frequency of HBPM were extracted for statistical analy⁃sis.Results A total of 21 guidelines developed by institutions in 16 countries or regions were included,con⁃taining recommendations related to the timing and/or frequency of HBPM.For the HBPM timing,all guidelines recommend that blood pressure measurements be taken twice a day,in the morning and evening.In the morning blood pressure should be measured before taking antihypertensive medication(94.4%,17/18),before break⁃fast(72.2%,13/18)and after urination(55.6%,10/18),while in the evening it should be taken before dinner(50.0%,8/16),before bedtime(37.5%,6/16)or 2 hours after dinner(6.3%,1/16).For HBPM frequency,9(40.9%,9/22)guidelines recommend at least 3 consecutive days of measurement in the week before the visit,and others suggest that measurements should be taken consecutively for at least 4 d(18.2%,4/22),5 d(13.6%,3/22)or 7 d(27.3%,6/22)days.Conclusions The guidelines of different countries and regions have great differences in recommendations on the timing and frequency of HBPM.It is recommended that future guideline developers develop the best recommendations after a thorough search,evaluation,and synthesis of the evidence,with full consideration of the balance of pros and cons,feasibility,patient preferences and values,as well as the context in which the guidelines are implemented.

关 键 词：高血压指南 家庭血压监测 推荐意见 

分 类 号：R181.2[医药卫生—流行病学] R544.1[医药卫生—公共卫生与预防医学]