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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-3251

摘要内容如下：

背景

住院期间血压升高（BP）的管理差异很大，许多住院成人的血压高于门诊建议的血压。

目的

系统地确定医院中血压升高管理的指南。

数据源

2010年1月1日至2024年1月29日的MEDLINE、指南国际网络和专业学会网站。

研究选择

门诊、急诊科和住院机构中成人和老年人群血压管理的临床实践指南。

数据提取

两位作者独立筛选文章、评估质量并提取数据。分歧通过协商一致得到解决。收集门诊和住院患者关于治疗目标、首选抗高血压药物类别和随访的建议。

数据综合

14项临床实践指南符合纳入标准（11项根据AGREE II[评估研究和评估指南II]工具评估为高质量），11项提供了广泛的血压管理建议，每项1项针对急诊科环境、老年人和高血压危象。没有指南提供住院患者血压的目标或在医院管理无症状中度升高血压的建议。6项指南将高血压急症定义为血压高于180/120毫米汞柱，高血压急症需要加上靶器官损害。高血压急诊建议始终包括在重症监护环境中使用静脉注射抗高血压药物。处理高血压急症的建议与专家共识不一致，并且集中在急诊科。最常建议的是口服药物的门诊治疗和数天至数周的随访。相反，门诊病人的血压目标是明确的，在130/80和140/90毫米汞柱之间。

局限性

排除非英语指南和特定于亚人群的指南。

结论

尽管对门诊血压管理达成了普遍共识，但缺乏对无症状血压升高的住院管理的指导，这可能导致不同的实践模式。

主要资金来源

国家老龄化研究所。（普洛斯彼罗：CRD42023449250）。

英文原文如下：

Abstracts

BACKGROUND  Management of elevated blood pressure (BP) during hospitalization varies widely, with many hospitalized adults experiencing BPs higher than those recommended for the outpatient setting.

PURPOSE  To systematically identify guidelines on elevated BP management in the hospital.

DATA SOURCES  MEDLINE, Guidelines International Network, and specialty society websites from 1 January 2010 to 29 January 2024.

STUDY SELECTION  Clinical practice guidelines pertaining to BP management for the adult and older adult populations in ambulatory, emergency department, and inpatient settings.

DATA EXTRACTION  Two authors independently screened articles, assessed quality, and extracted data. Disagreements were resolved via consensus. Recommendations on treatment targets, preferred antihypertensive classes, and follow-up were collected for ambulatory and inpatient settings.

DATA SYNTHESIS  Fourteen clinical practice guidelines met inclusion criteria (11 were assessed as high-quality per the AGREE II [Appraisal of Guidelines for Research & Evaluation II] instrument), 11 provided broad BP management recommendations, and 1 each was specific to the emergency department setting, older adults, and hypertensive crises. No guidelines provided goals for inpatient BP or recommendations for managing asymptomatic moderately elevated BP in the hospital. Six guidelines defined hypertensive urgency as BP above 180/120 mm Hg, with hypertensive emergencies requiring the addition of target organ damage. Hypertensive emergency recommendations consistently included use of intravenous antihypertensives in intensive care settings. Recommendations for managing hypertensive urgencies were inconsistent, from expert consensus, and focused on the emergency department. Outpatient treatment with oral medications and follow-up in days to weeks were most often advised. In contrast, outpatient BP goals were clearly defined, varying between 130/80 and 140/90 mm Hg.

LIMITATION  Exclusion of non-English-language guidelines and guidelines specific to subpopulations.

CONCLUSION  Despite general consensus on outpatient BP management, guidance on inpatient management of elevated BP without symptoms is lacking, which may contribute to variable practice patterns.

PRIMARY FUNDING SOURCE  National Institute on Aging. (PROSPERO: CRD42023449250).

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