目前的预防指南,检测,评估,和高血压的管理推荐六种类型的非药物干预措施:酒精减少,盐摄入量减少,钾摄入量增加,身体活动,减肥,和心脏健康的饮食。然而,非药物干预仍未广泛用于初级保健.在本文中,我们,因此,审查并总结了有效性的证据,成本效益,障碍,以及在初级保健中治疗高血压的非药物干预措施的促进者。
在Embase进行了全面的文献检索,谷歌学者,和PubMed数据库,以确定最新的评论或,在他们缺席的情况下,关于酒精减少的主要研究,盐摄入量减少,补钾,身体活动,减轻体重,心脏健康的饮食,和其他非药物干预措施在初级保健中治疗高血压。
减少酒精是一种在初级保健中治疗高血压的非药物干预措施,已证明有效,可行性,和可接受性。减少钠摄入量的干预措施,身体活动,和减轻体重是有效的,但没有足够的证据表明它们在初级保健环境中的可行性和可接受性。关于钾摄入和心脏健康饮食有效性的证据有限且不一致。缺乏关于非药物干预治疗高血压的成本效益的证据。提供与医疗保健提供者相关的此类干预措施的最常见障碍包括缺乏时间,知识,自信,资源,明确的指导方针,和财政激励。与患者相关的最常见障碍包括缺乏动力和教育资源。关于在初级保健中实施非药物干预措施的促进者的证据较少。此外,促进者因不同类型的干预而有所不同。
现有证据表明,更务实,临床上可行,减少钠摄入量需要后勤上简单的干预措施,身体活动,在初级保健环境中减轻体重。未来的研究应该为体重控制的有效性提供进一步的证据。钾摄入量,和心脏健康的饮食。还需要对初级保健中治疗高血压的所有类型的有效非药物干预措施的成本效益和促进因素进行更多的研究。
The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care.
A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care.
Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions.
Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.