大人の高血圧のスクリーニング:米国の予防サービスタスクフォースの最新証拠報告と体系的なレビュー
Janelle M Guirguis-Blake1,2, Corinne V Evans2, Elizabeth M Webber2
1Department of Family Medicine, University of Washington, Tacoma.
JAMA
|April 27, 2021
まとめ
診察室での血圧測定による高血圧スクリーニングは精度が限られていますが,直接的な害は最小です. より良い心血管疾患予防のためにスクリーニングと確認方法を最適化するためにさらなる研究が必要です.
科学分野:
- 心血管医学
- 予防的な心臓科
- 診断の精度に関する研究
背景:
- 高血圧は心臓血管疾患 (CVD) の重要な危険因子です.
- 効果的なスクリーニングと血圧測定の戦略は,CVDのリスクを低減するために不可欠です.
- ライフスタイルと薬学的介入は高血圧を修正し,心血管疾患と死亡率を減らすことができます.
研究 の 目的:
- 成人におけるスクリーニングと血圧確認の利害を体系的に検討する.
- 高血圧スクリーニングに関する米国予防サービスタスクフォースのガイドラインを提示する.
- 各種の血圧測定技術の正確性と安全性を評価する.
主な方法:
- ランダム化臨床試験 (RCT),非ランダム化制御介入試験,および観察試験の体系的レビュー.
- 2021年3月までのデータソースには,MEDLINE,PubMed,Cochrane,CINAHLが含まれています.
- 効果,正確性,有害性に関するデータを集約するために,メタアナリシスと定性合成を用いた.
主要な成果:
- 高血圧スクリーニングを含む多成分介入は,心血管疾患の入院を減少させた.
- オフィスベースのスクリーニングは,0. 54のプーリング感度と0. 90の特異性を持ち,有意な異質性がありました.
- 事務所での確認測定では,総感度が0. 80で,特異性は0. 55であった.自宅での確認では,感度が0. 84で,特異性は0. 60であった.
- スクリーニングは生活の質や心理的苦痛に悪影響を及ぼさなかった.欠席の証拠は混在していた.
- 診察室での血圧モニタリングは一時的な睡眠障害と傷を引き起こした.
結論:
- オフィスベースの血圧スクリーニングは,誤診につながる可能性のある顕著な精度制限があります.
- 血圧測定に関連する直接的な害は,一般的に最小限です.
- 最適なスクリーニングと確認アルゴリズムは,臨床実施のためのさらなる研究を必要とします.
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