PDF(Pubmed)
Abstract：
UNASSIGNED: Management of elevated blood pressure (BP) during hospitalization varies widely, with many hospitalized adults experiencing BPs higher than those recommended for the outpatient setting.
UNASSIGNED: To systematically identify guidelines on elevated BP management in the hospital.
UNASSIGNED: MEDLINE, Guidelines International Network, and specialty society websites from 1 January 2010 to 29 January 2024.
UNASSIGNED: Clinical practice guidelines pertaining to BP management for the adult and older adult populations in ambulatory, emergency department, and inpatient settings.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Exclusion of non-English-language guidelines and guidelines specific to subpopulations.
UNASSIGNED: 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.
UNASSIGNED: National Institute on Aging. (PROSPERO: CRD42023449250).
UNASSIGNED: To systematically identify guidelines on elevated BP management in the hospital.
UNASSIGNED: MEDLINE, Guidelines International Network, and specialty society websites from 1 January 2010 to 29 January 2024.
UNASSIGNED: Clinical practice guidelines pertaining to BP management for the adult and older adult populations in ambulatory, emergency department, and inpatient settings.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Exclusion of non-English-language guidelines and guidelines specific to subpopulations.
UNASSIGNED: 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.
UNASSIGNED: National Institute on Aging. (PROSPERO: CRD42023449250).
摘要：
■住院期间血压升高（BP）的管理差异很大，许多住院成人的BPs高于门诊推荐的BPs。
■系统地确定医院血压升高管理指南。
■MEDLINE,国际网络准则，和专业协会网站，2010年1月1日至2024年1月29日。
■门诊成人和老年人群血压管理的临床实践指南，急诊科,和住院设置。
■两位作者独立筛选了文章，评估质量，并提取数据。分歧通过协商一致解决。关于治疗目标的建议，首选抗高血压药，并收集了门诊和住院设置的随访。
■14项临床实践指南符合纳入标准（根据AGREEII[评估与评估指南II]工具评估了11项高质量），11提供了广泛的BP管理建议，每个都是针对急诊科设置的，老年人,和高血压危机。没有指南提供住院患者BP的目标或在医院管理无症状中度升高的BP的建议。六个指南将高血压紧迫性定义为血压高于180/120mmHg，高血压急症需要增加靶器官损伤。高血压急诊建议始终包括在重症监护环境中使用静脉抗高血压药。管理高血压急症的建议不一致，从专家共识来看，专注于急诊科。最常建议门诊口服药物治疗和几天到几周的随访。相比之下,明确了门诊血压目标，在130/80和140/90mmHg之间变化。
■排除非英语指南和特定于亚群的指南。
■尽管对门诊血压管理达成了普遍共识，缺乏无症状的血压升高的住院管理指导，这可能会导致不同的实践模式。
■国家老龄研究所。（PROSPERO：CRD42023449250）。
■系统地确定医院血压升高管理指南。
■MEDLINE,国际网络准则，和专业协会网站，2010年1月1日至2024年1月29日。
■门诊成人和老年人群血压管理的临床实践指南，急诊科,和住院设置。
■两位作者独立筛选了文章，评估质量，并提取数据。分歧通过协商一致解决。关于治疗目标的建议，首选抗高血压药，并收集了门诊和住院设置的随访。
■14项临床实践指南符合纳入标准（根据AGREEII[评估与评估指南II]工具评估了11项高质量），11提供了广泛的BP管理建议，每个都是针对急诊科设置的，老年人,和高血压危机。没有指南提供住院患者BP的目标或在医院管理无症状中度升高的BP的建议。六个指南将高血压紧迫性定义为血压高于180/120mmHg，高血压急症需要增加靶器官损伤。高血压急诊建议始终包括在重症监护环境中使用静脉抗高血压药。管理高血压急症的建议不一致，从专家共识来看，专注于急诊科。最常建议门诊口服药物治疗和几天到几周的随访。相比之下,明确了门诊血压目标，在130/80和140/90mmHg之间变化。
■排除非英语指南和特定于亚群的指南。
■尽管对门诊血压管理达成了普遍共识，缺乏无症状的血压升高的住院管理指导，这可能会导致不同的实践模式。
■国家老龄研究所。（PROSPERO：CRD42023449250）。
