老年高血压病人家庭自测血压管理效果的Meta分析

Effect of home-based self-monitoring blood pressure in the management of elderly patients with hypertension:a Meta-analysis

[目的]评价家庭自测血压应用于老年高血压病人的管理效果。[方法]2020年3月1日系统检索中国生物医学文献数据库、维普、万方、中国知网、PubMed、Web of Science数据,纳入家庭自测血压应用于老年高血压管理效果的随机对照试验(RCT),对符合质量标准的文献采用RevMan 5.3软件进行Meta分析。[结果]共纳入10篇文献,涉及1760例病人。Meta分析结果显示,家庭自测血压均可改善家庭测量收缩压[MD=-7.80,95%CI(-8.93,-6.67),P<0.00001]、家庭测量舒张压[MD=-4.12,95%CI(-6.58,-1.66),P=0.001]、诊室测量收缩压[MD=-9.55,95%CI(-14.07,-5.04),P<0.0001]、诊室测量舒张压[MD=-4.69,95%CI(-7.14,-2.24),P=0.0002]、家庭测量血压达标率[RR=1.40,95%CI(1.05,1.86),P=0.02]、诊室测量血压达标率[RR=1.39,95%CI(1.22,1.59),P<0.00001];亚组分析发现家庭自测血压可改善干预时间>24个月的诊室测量收缩压[MD=-11.50,95%CI(-13.22,-9.78),P<0.00001]、干预时间>12个月的家庭测量舒张压[MD=-4.90,95%CI(-6.82,-2.97),P<0.00001]、干预时间>24个月的诊室测量舒张压[MD=-4.35,95%CI(-5.56,-3.13),P<0.00001]、医院门诊病人血压达标率[RR=1.78,95%CI(1.48,2.15),P<0.00001]合并结果具有统计学意义(P<0.05,I 2<50%)。[结论]现有研究证据表明,家庭自测血压干预具有一定效果,但是受干预时间、病人来源、不同干预措施的影响。

Objective:To evaluate the management effect of home-based self-monitoring blood pressure in elderly patients with hypertension.Methods:Randomized controlled trials(RCTs)on the management effect of home-based self-monitoring blood pressure in elderly patients with hypertension,were retrieved from China Biomedical Database,VIP,Wanfang,CNKI,PubMed,and Web of Science on March 1,2020.Revman 5.3 software was used for Meta-analysis among studies that met the quality standards.Results:A total of 10 articles were included,involving 1760 patients.The Meta-analysis results showed that home-based self-monitoring blood pressure could improve home systolic blood pressure[MD=-7.80,95%CI(-8.93,-6.67),P<0.00001],home measured diastolic blood pressure[MD=-4.12,95%CI(-6.58,-1.66),P=0.001],office measured systolic blood pressure[MD=-9.55,95%CI(-14.07,-5.04),P=0.00001],and room measured diastolic blood pressure[MD=-4.69,95%CI(-7.14,-2.24),P=0.0002],the control rate of home blood pressure measurement[RR=1.40,95%CI(1.05,1.86),P=0.02],and the compliance rate of blood pressure measured in clinics[RR=1.39,95%CI(1.22,1.59),P<0.00001].Subgroup analysis showed that family self-monitoring blood pressure could improve the clinics-based measured systolic blood pressure with intervention time>24 months[MD=-11.50,95%CI(-13.22,-9.78),P<0.00001],family measured diastolic blood pressure with intervention time>12 months[MD=-4.90,95%CI(-6.82,-2.97),P<0.00001],and clinics-based monitoring diastolic blood pressure with intervention time>24 months[MD=-4.35,95%CI(-5.56,-3.13),P<0.00001],the control rate of blood pressure reaching standard of outpatients[RR=1.78,95%CI(1.48,2.15),P<0.00001],the combined results were statistically significant(P<0.05,I 2<50%).Conclusion:The current research results show that home-based self-monitoring blood pressure intervention has a certain effect.But it could be affected by intervention time,patient source,and different intervention measures.