成年人高血压查:美国预防服务工作组的最新证据报告和系统审查
Janelle M Guirguis-Blake1,2, Corinne V Evans2, Elizabeth M Webber2
1Department of Family Medicine, University of Washington, Tacoma.
JAMA
|April 27, 2021
概括
通过办公室血压测量进行高血压查的准确性有限,但直接的危害很小. 需要进一步研究以优化查和确认方法以更好地预防心血管疾病.
科学领域:
- 心血管医学
- 预防性心脏病学
- 诊断准确性的研究
背景情况:
- 高血压是心血管疾病 (CVD) 的重要危险因素.
- 有效的查和验证血压测量策略对于降低心血管疾病风险至关重要.
- 生活方式和药物干预可以改变高血压并减少心血管事件和死亡率.
研究的目的:
- 系统地审查成年人的查和验证血压测量的益处和危害.
- 为美国预防服务工作组提供有关高血压查的指导方针.
- 评估各种血压测量技术的准确性和安全性.
主要方法:
- 随机临床试验 (RCT),非随机控制干预研究和观察性研究的系统审查.
- 数据来源包括到2021年3月的MEDLINE,PubMed,Cochrane和CINAHL.
- 使用元分析和定性合成来汇集有效性,准确性和危害的数据.
主要成果:
- 包括高血压查在内的多组分干预措施减少了心血管病患者入院.
- 基于办公室的查具有0. 54的综合灵敏度和0. 90的特异性,具有显著的异质性.
- 在办公室进行的确认测量显示总体灵敏度为0.80和特异性为0.55;在家庭进行的确认测量显示灵敏度为0.84和特异性为0.60.
- 查没有对生活质量或心理困扰产生负面影响;缺勤证据是混合的.
- 门诊血压监测导致暂时的睡眠障碍和伤.
结论:
- 基于办公室的血压查具有显著的准确性限制,可能导致误诊.
- 与血压测量相关的直接危害通常是最小的.
- 最佳的查和确认算法需要进一步的临床实施研究.
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