Awareness, Knowledge, and Attitudes Toward Screening and Treatment of Masked Hypertension in Primary Care.
Awareness, Knowledge, and Attitudes Toward Screening and Treatment of Masked Hypertension in Primary Care.
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初级保健中对隐匿性高血压筛查和治疗的认识、知识和态度。
DOI：
10.1093/ajh/hpab115
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发表时间：
2021
影响因子：
3.2
通讯作者：
Kronish,IanM
中科院分区：
文献类型：
--
作者：
Boyd,Rebekah;Carter,Eileen;Moise,Nathalie;Alcántara,Carmela;Valadares,Thais;Anstey,DEdmund;Kronish,IanM
背景高血压指南建议对隐性高血压(MHT)进行筛查和治疗。然而，很少有初级保健提供者(PCP)对MHT进行筛查，对初级保健提供者(PCP)对MHT的认识、知识和态度也知之甚少。对焦点组成绩单进行主题内容分析。结果人们对MHT的认识各不相同，只有2名提供者诊断出MHT。对MHT的患病率和影响也知之甚少。虽然一些PCP在了解了MHT的重要性后接受了MHT筛查，但其他人认为目前的证据不足以改变做法。提供者对将办公室血压(BP)未升高的患者贴上高血压标签感到不安，不愿在没有更有力证据的情况下在他们的工作量中增加另一项筛查测试。人们对家庭血压监测筛查MHT的准确性表示怀疑。人们对动态血压监测(ABPM)用于MHT筛查更有信心，但ABPM被认为基本上无法获得。人们普遍同意改变MHT的生活方式。有人担心降压药缺乏随机试验的证据，可能会导致有害的副作用。结论PCP对MHT的了解有限，对筛查试验的准确性和可及性的担忧，PCP超载和证据不足是MHT筛查和治疗的主要障碍。在PCP广泛采用之前，可能需要进行随机试验，证明MHT筛查和治疗的净效益，同时增加关于MHT的知识传播，并改善获得ABPM的机会。
BackgroundHypertension guidelines recommend screening and treatment for masked hypertension (MHT). Yet, few primary care providers (PCPs) screen for MHT, and little is known about PCP awareness, knowledge, and attitudes toward MHT.MethodsThree focus groups involving 30 PCPs from 3 medical centers in New York were conducted. Focus group transcripts were analyzed using thematic content analysis.ResultsAwareness of MHT varied, and only 2 providers had diagnosed MHT. There was also low knowledge about the prevalence and impact of MHT. While some PCPs were receptive to MHT screening after learning about its significance, others viewed the current evidence as insufficient to change practice. Providers were discomforted by labeling patients with nonelevated office blood pressure (BP) as hypertensive and reluctant to add another screening test to their workload without stronger evidence. There was distrust in the accuracy of home BP monitoring to screen for MHT. There was more confidence in ambulatory BP monitoring (ABPM) for MHT screening, but ABPM was viewed as largely inaccessible. There was broad agreement with lifestyle changes for MHT. There were concerns that antihypertensive medication lacked evidence from randomized trials and could induce harmful side effects.ConclusionsLimited PCP knowledge about MHT, concerns about the accuracy and accessibility of screening tests, overloaded PCPs, and insufficient evidence were major barriers to screening and treatment for MHT. Prior to broad uptake by PCPs, randomized trials demonstrating the net benefits of MHT screening and treatment may be needed, along with increased dissemination of knowledge about MHT and improved access to ABPM.