West Midlands Centre for Adverse Drug Reactions, Birmingham, UK.
Drug Saf. 2011 Nov 1;34(11):1049-59. doi: 10.2165/11593980-000000000-00000.
Biochemical monitoring of patients treated with antihypertensive therapy is recommended in order to identify potential adverse reactions to treatment. We aimed to review the literature investigating the nature of biochemical monitoring in adults treated in primary care with antihypertensive drugs. Specifically, we wished to establish (i) the proportion of patients with biochemical baseline testing prior to the initiation of antihypertensive therapy; (ii) the proportion of patients with biochemical monitoring after initiation of antihypertensive therapy; (iii) the patient characteristics associated with biochemical monitoring; (iv) the frequency of biochemical monitoring after the initiation of antihypertensive therapy; and (v) the relationship, if any, between biochemical monitoring and adverse patient outcomes. We searched MEDLINE, EMBASE and Google Scholar from 1948 to 31 December 2010 using a combination of text words and search terms. Retrospective and prospective cohort studies, cross-sectional studies, randomized controlled trials or quasi-randomized controlled trials, and audits of current clinical practice were included. Clinical trials, case reports and case series were excluded. Studies were included if they provided data on the proportion of patients treated with antihypertensive therapy in primary care who had any biochemical monitoring before or after the initiation of therapy. In total, 15 studies were included in our review, which used a wide variety of definitions of monitoring prior to and after the initiation of antihypertensive therapy. From 17% to 81% of patients treated with antihypertensive drugs had a baseline biochemical test and from 20% to 79% had any follow-up monitoring. In only 7 of the 12 studies that examined follow-up monitoring did more than half of the patients have any monitoring. Overall, this systematic review provides evidence that monitoring as recommended by published guidelines is not commonly undertaken. Only two studies were identified that examined patients with both baseline testing and follow-up monitoring. Omission of one or the other limits the ability to analyse the effect of treatment on electrolyte concentrations or renal function. There is limited research on the patient factors associated with monitoring and further work is required to determine the impact of monitoring on adverse patient outcomes. Important barriers to effective monitoring exist and this review emphasizes that these have not yet been overcome.
为了识别潜在的治疗不良反应，建议对接受降压治疗的患者进行生化监测。我们旨在回顾调查成人在初级保健中接受降压药物治疗时生化监测性质的文献。具体而言，我们希望确定：（i）开始降压治疗前进行生化基线检测的患者比例；（ii）开始降压治疗后进行生化监测的患者比例；（iii）与生化监测相关的患者特征；（iv）开始降压治疗后进行生化监测的频率；以及（v）如果存在生化监测，其与不良患者结局之间的关系。我们检索了 MEDLINE、EMBASE 和 Google Scholar 数据库，检索时间从 1948 年到 2010 年 12 月 31 日，使用了文本词和检索词的组合。纳入了回顾性和前瞻性队列研究、横断面研究、随机对照试验或类随机对照试验以及当前临床实践的审计。排除了临床试验、病例报告和病例系列。如果研究提供了关于初级保健中接受降压治疗的患者在开始治疗前后进行任何生化监测的患者比例的数据，则纳入研究。我们的综述共纳入了 15 项研究，这些研究使用了广泛的治疗前后监测定义。在接受降压药物治疗的患者中，有 17%至 81%的患者进行了生化基线检测，有 20%至 79%的患者进行了任何随访监测。在 12 项检查随访监测的研究中，仅有 7 项研究超过一半的患者进行了监测。总体而言，本系统评价提供了证据表明，按照已发表指南推荐的监测方法并不常见。仅确定了两项研究同时检查了基线检测和随访监测的患者。遗漏其中一项或另一项限制了分析治疗对电解质浓度或肾功能影响的能力。关于与监测相关的患者因素的研究有限，需要进一步研究来确定监测对不良患者结局的影响。有效监测存在重要障碍，本综述强调这些障碍尚未得到克服。
