Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-analysis.
Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-analysis.
复制标题
高血压患者的血压控制实施策略的比较有效性：系统的综述和荟萃分析。
DOI：
10.7326/m17-1805
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发表时间：
2018-01-16
影响因子：
39.2
通讯作者：
He J
中科院分区：
文献类型：
--
作者：
Mills KT;Obst KM;Shen W;Molina S;Zhang HJ;He H;Cooper LA;He J
高血压的患病率很高，在世界范围内不断增加，而高血压得到控制的比例很低。评估8种血压控制策略在成人高血压患者中的比较有效性。MEDLINE和Embase从开始到2017年9月的系统检索，无语言限制，辅以手动参考文献检索。持续至少6个月的随机对照试验，比较实施策略与常规护理对成年高血压患者降压的影响。两名研究者独立提取试验数据。根据实施策略对试验进行分组，并使用多变量调整的广义估计方程比较血压降低效果。使用改良的科克伦偏倚风险工具进行试验质量评估。共纳入了来自100篇文章的121项比较，涉及55，920例高血压患者。多水平、多成分策略，如由非医生进行药物滴定的团队护理[−7.1 mmHg（95% CI：−8.9，−5.2）]、由医生进行药物滴定的团队护理[−6.2 mmHg（−8.1，−4.2）]和无团队护理的多水平策略[−5.0 mmHg（−8.0，−2.0）]对降低收缩压最有效。患者层面的策略也导致健康指导的收缩压显著降低了-3.9 mmHg（-5.4，-2.3），家庭血压监测的收缩压显著降低了-2.7 mmHg（-3.6，-1.7）。舒张压降低也观察到类似的趋势。在少数试验中测试了提供者培训，结果血压降低不显著。来自低收入和中等收入国家的数据稀少，一些实施策略的试验很少，可能存在出版偏倚。多水平、多成分策略，其次是患者水平策略，对高血压患者的血压控制最有效，应用于改善高血压控制。美国国立卫生研究院
The prevalence of hypertension is high and increasing worldwide while the proportion of controlled hypertension is low. To assess the comparative effectiveness of 8 implementation strategies for blood pressure (BP) control in adults with hypertension. Systematic searches of MEDLINE and Embase from inception to September 2017 with no language restriction supplemented with manual reference searches. Randomized controlled trials lasting at least 6 months comparing implementation strategies versus usual care on BP reduction in adults with hypertension. Two investigators independently extracted trial data. Trials were grouped by implementation strategy, and BP reduction effects were compared using multivariate-adjusted generalized estimating equations. A modified Cochrane Risk of Bias tool was used for trial quality assessment. A total of 121 comparisons from 100 articles with 55,920 hypertensive patients were included. Multilevel, multicomponent strategies, such as team-based care with medication titration by non-physician [−7.1 mmHg (95% CI: −8.9, −5.2)], team-based care with medication titration by physician [−6.2 mmHg (−8.1, −4.2)], and multilevel strategies without team-based care [−5.0 mmHg (−8.0, −2.0)] were most effective for systolic BP reduction. Patient-level strategies also resulted in significant systolic BP reductions of −3.9 mmHg (−5.4, −2.3) for health coaching and −2.7 mmHg (−3.6, −1.7) for home BP monitoring. Similar trends were observed for diastolic BP reduction. Provider training was tested in few trials and resulted in non-significant BP reduction. Sparse data from low- and middle-income countries, few trials of some implementation strategies, and possible publication bias. Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for BP control in patients with hypertension and ought to be used to improve hypertension control. US National Institutes of Health