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Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2018-05-01 , DOI: 10.1016/j.jacc.2017.11.004
David M Reboussin , Norrina B Allen , Michael E Griswold , Eliseo Guallar , Yuling Hong , Daniel T Lackland , Edgar Pete R Miller , Tamar Polonsky , Angela M Thompson-Paul , Suma Vupputuri

OBJECTIVE To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (i.e., angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.

中文翻译:

2017 年 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA 成人高血压预防、检测、评估和管理指南的系统审查

目的 系统地回顾文献并进行荟萃分析来解决以下问题:1) 是否有证据表明,在没有其他增强措施的情况下,自我测量血压 (BP) 优于办公室血压测量,以实现更好的血压控制或预防与血压升高相关的不良临床结果?2) 成人降压治疗期间的最佳降压目标是什么?3) 对于成人高血压患者,不同类别的抗高血压药物作为一线治疗的益处和危害有何不同?方法 全球医学证据软件和服务公司 Doctor Evidence 从 1966 年到 2015 年在 PubMed 和 EMBASE 上进行了电子文献检索,使用关键词和相关主题标题进行随机对照试验,这些试验符合为每个问题定义的资格标准。我们使用传统的频率统计和贝叶斯方法进行分析,包括随机效应贝叶斯网络荟萃分析。结果 我们的结果表明:1) 在 6 个月而非 12 个月的自我测量血压与常规治疗的随机对照试验中,收缩压有适度但显着的改善,对于选定的患者及其提供者来说,自我测量血压可能会有所改善。日常办公室护理的有用辅助。2) 收缩压降低至<130 mm Hg 的目标可能会降低多种重要结局的风险,包括心肌梗死、中风、心力衰竭和主要心血管事件的风险。作为一线治疗,没有任何一类药物(即血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、钙通道阻滞剂或β受体阻滞剂)明显优于噻嗪类和噻嗪类利尿剂。
更新日期:2018-05-01
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