作者：代炜，黄沂，赵玉玲，张亦然

单位：

1.530001广西壮族自治区南宁市，广西中医药大学护理学院　2.530023广西壮族自治区南宁市，广西中医药大学第一 附属医院护理部

Units：

1.School of Nursing, Guangxi University of Chinese Medicine, Nanning 530001, China 2.Nursing Department, the First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530023, China

关键词：

高血压；冠心病；血压管理；循证医学；证据

Keywords：

Hypertension; Coronary heart disease; Blood pressure management; Evidence-based medicine; Evidence

CLC：

R 743.3

DOI：

10.12114/j.issn.1008-5971.2023.00.254

Funds：

国家自然科学基金资助项目（72164003）；广西中医药大学研究生教育创新计划项目（YCSZ2022021）；广西中医药 重点学科建设项目（GZXK-Z-20-56）；广西壮族自治区中医药管理局课题（GZSY21-20）

摘要：

目的　总结高血压合并冠心病患者血压管理的最佳证据。方法　按照“6S”金字塔证据模型检索BMJ Best Practice、UpToDate、国际指南协作网、美国国立指南库、加拿大安大略省注册护士协会（RNAO）网站、英国国 家卫生与临床优化研究所网站、苏格兰院际指南网（SIGN）、澳大利亚临床实践指南平台、新西兰指南工作组网站、 国际高血压学会网站、日本高血压学会网站、美国心脏协会（AHA）网站、欧洲心脏病学会（ESC）网站、法国高血 压学会（FSAH）网站、韩国高血压学会网站、意大利心血管疾病预防学会网站、Nursing Consult、Embase、Cochrane Library、PubMed、医脉通、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库等网站或数据库中 关于高血压合并冠心病患者血压管理的文献。检索时限为建库至2023年3月。由2名研究者进行文献筛选、内容提取、 文献质量评价（指南为4名）及证据提取与证据等级评价。结果　共纳入文献19篇，包括8篇指南、5篇系统评价、3篇 专家共识、2篇随机对照试验、1篇临床决策。纳入的1篇临床决策，原始文献为1篇随机对照试验、3篇系统评价（总 分均为11.0分）；纳入的8篇指南中4篇指南的推荐级别为A级，4篇指南的推荐级别为B级；纳入的3篇专家共识总分 均≥5.5分；纳入的5篇系统评价的总分均≥9.0分；纳入的2篇随机对照试验中SPRINT Research Group等研究的所有条 目评价为“是”，SHERWOOD等研究的条目4和条目5评价为“不清楚”，其他条目评价为“是”。通过提取与整合 证据，最终形成了高血压合并冠心病患者血压管理的最佳证据，包括系统评估血压、降压目标、降压策略、非药物干 预、随访及院外血压管理5个方面共34个条目。结论　该研究总结了包括系统评估血压、降压目标、降压策略、非药 物干预、随访及院外血压管理5个方面共34个条目的高血压合并冠心病患者血压管理的最佳证据，为临床制定规范的 高血压合并冠心病患者血压管理方案提供了借鉴。

Abstract：

Objective To summarize the best evidence of blood pressure management in hypertension patients complicated with coronary heart disease. Methods According to the "6S" evidence-based resource pyramid model, the literature about blood pressure management in hypertension patients complicated with coronary heart disease which were published in BMJ Best Practice, UpToDate, Guidelines International Network, National Guideline Clearinghouse, Canadian Registered Nurses' Association of Ontario (RNAO) website, National Institute for Health and Care Excellence website, Scottish Intercollegiate Guidelines Network (SIGN) , Australian Clinical Practice Guidelines Platform, New Zealand Guidelines Group website, International Society of Hypertension website, Japanese Society of Hypertension website, American Heart Association (AHA) website, European Society of Cardiology (ESC) website, French Society of Arterial Hypertension (FSAH) website, Korean Society of Hypertension website, Italian Society of Cardiovascular Prevention website, Nursing Consult, Embase, Cochrane Library, PubMed, Medlive, CNKI, Wanfang Data, VIP, China Biomedical Literature Database were searched. The search time was the establishment of the database to March 2023. Two researchers, conducted literature screening, extracted content, evaluated the quality of the included literature (guidline: 4) , extracted evidence and evaluated evidence level. Results A total of 19 literature were included, including 8 guidelines, 5 system assessments, 3 expert consensus, 2 randomized controlled trials, and 1 clinical decision. One clinical decision was included, and the evidence was extracted from one randomized controlled trial and three systematic reviews (with a total quality score of 11.0) . Among the 8 guidelines, 4 guidelines had a recommendation level of A, and 4 guidelines had a recommendation level of B. Three expert consensus had a total quality score of ≥ 5.5. Five system assessments had a total quality score of ≥ 9.0. In the two randomized controlled trials, all items of SPRINT Research Group et al.'s study were "yes" ; in the study of SHERWOOD et al., item 4 and item 5 were "unclear" , the other items were "yes" . Through the extraction and integration of evidence, the best evidence of blood pressure management in hypertension patients complicated with coronary heart disease including 34 items in 5 dimensions of blood pressure systematic evaluation, antihypertensive goals, antihypertensive strategies, non-drug intervention, follow-up and out-of-hospital blood pressure management was formed. Conclusion This study summarizes the best evidence of blood pressure management in hypertension patients complicated with coronary heart disease including 34 items in 5 dimensions of systematic evaluation of blood pressure, antihypertensive goals, antihypertensive strategies, non-drug intervention, follow-up and out-of-hospital blood pressure management, and provides reference for the clinical development of standardized blood pressure management program for hypertension patients complicated with coronary heart disease.

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