Brokmann Jörg C, Rossaint Rolf, Müller Michael, Fitzner Christina, Villa Luigi, Beckers Stefan K, Bergrath Sebastian
Emergency Department, University Hospital RWTH Aachen, Aachen, Germany.
Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
J Clin Hypertens (Greenwich). 2017 Jul;19(7):704-712. doi: 10.1111/jch.13026. Epub 2017 May 30.
Prehospital hypertensive emergencies and urgencies are common, but evidence is lacking. Telemedically supported hypertensive emergencies and urgencies were prospectively collected (April 2014-March 2015) and compared retrospectively with a historical control group of on-scene physician care in the emergency medical service of Aachen, Germany. Blood pressure management and guideline adherence were evaluated. Telemedical (n=159) vs conventional (n=172) cases: blood pressure reductions of 35±24 mm Hg vs 44±23 mm Hg revealed a group effect adjusted for baseline differences (P=.0006). Blood pressure management in categories: no reduction 6 vs 0 (P=.0121); reduction ≤25% (recommended range) 113 vs 110 patients (P=.2356); reduction >25% to 30% 13 vs 29 (0.020); reduction >30% 12 vs 16 patients (P=.5608). The telemedical approach led to less pronounced blood pressure reductions and a tendency to improved guideline adherence. Telemedically guided antihypertensive care may be an alternative to conventional care especially for potentially underserved areas.
院前高血压急症和亚急症很常见，但缺乏相关证据。我们前瞻性收集了远程医疗支持下的高血压急症和亚急症病例（2014年4月至2015年3月），并与德国亚琛紧急医疗服务中现场医生护理的历史对照组进行回顾性比较。评估了血压管理和指南遵循情况。远程医疗组（n = 159）与传统组（n = 172）：血压降低幅度分别为35±24 mmHg和44±23 mmHg，经基线差异校正后显示出组间效应（P = 0.0006）。血压管理分类情况：未降低的患者，远程医疗组有6例，传统组为0例（P = 0.0121）；降低幅度≤25%（推荐范围）的患者，远程医疗组有113例，传统组有110例（P = 0.2356）；降低幅度>25%至30%的患者，远程医疗组有13例，传统组有29例（P = 0.020）；降低幅度>30%的患者，远程医疗组有12例，传统组有16例（P = 0.5608）。远程医疗方法导致血压降低幅度较小，且有提高指南遵循率的趋势。远程医疗指导的降压护理可能是传统护理的一种替代方案，尤其适用于潜在服务不足的地区。
