临床实践指南中家庭血压监测时间和频率的推荐意见对比分析

  目的  对比分析临床实践指南中家庭血压监测(home blood pressure monitoring，HBPM)时间和频率的推荐意见，以帮助临床医生遴选最佳推荐意见，同时为未来指南推荐意见的形成提供建议。  方法  系统检索和筛选近5年发表的高血压相关临床实践指南，提取HBPM时间和频率的推荐意见进行统计分析。  结果  共纳入包含HBPM时间和/或频率相关推荐意见的指南21篇，分别由16个国家或地区的机构制定。对于HBPM时间，所有指南均推荐每天进行早晚两次血压测量，早上血压测量时间为服用降压药前(94.4%，17/18)、早餐前(72.2%，13/18)和排尿后(55.6%，10/18)，晚上血压测量时间为晚餐前(50.0%，8/16)、睡前(37.5%，6/16)和晚餐后2 h(6.3%，1/16)。对于HBPM频率，9篇(40.9%，9/22)指南建议就诊前1周至少连续测量3 d，其他指南则建议至少连续测量4 d(18.2%，4/22)、5 d(13.6%，3/22)或7 d(27.3%，6/22)。  结论  不同国家和地区的指南关于HBPM时间和频率的推荐意见存在较大差异，建议未来在形成推荐意见时应全面检索、评价和综合证据，充分考虑利弊平衡、可行性、患者偏好与价值观等因素，同时结合指南的实施环境，形成最佳推荐意见。

Comparative Analysis of Recommendations for Timingand Frequency of Home Blood Pressure Monitoring in Clinical Practice Guidelines

  Objective  To compare and analyze the recommendations for the timing and frequency of home blood pressure monitoring (HBPM) in clinical practice guidelines to help clinicians select the best recommendations and provide suggestions for the development of recommendations in the future.  Methods  Clinical practice guidelines related to hypertension published in the last five years were systematically searched and screened, and the recommendations for the timing and frequency of HBPM were extracted for statistical analysis.  Results  A total of 21 guidelines developed by institutions in 16 countries or regions were included, containing recommendations related to the timing and/or frequency of HBPM. For the HBPM timing, all guidelines recommend that blood pressure measurements be taken twice a day, in the morning and evening. In the morning blood pressure should be measured before taking antihypertensive medication (94.4%, 17/18), before breakfast (72.2%, 13/18) and after urination (55.6%, 10/18), while in the evening it should be taken before dinner (50.0%, 8/16), before bedtime (37.5%, 6/16) or 2 hours after dinner (6.3%, 1/16).For HBPM frequency, 9 (40.9%, 9/22) guidelines recommend at least 3 consecutive days of measurement in the week before the visit, and others suggest that measurements should be taken consecutively for at least 4 d (18.2%, 4/22), 5 d (13.6%, 3/22) or 7 d (27.3%, 6/22) days.  Conclusions  The guidelines of different countries and regions have great differences in recommendations on the timing and frequency of HBPM. It is recommended that future guideline developers develop the best recommendations after a thorough search, evaluation, and synthesis of the evidence, with full consideration of the balance of pros and cons, feasibility, patient preferences and values, as well as the context in which the guidelines are implemented.