Rehm Jürgen, Anderson Peter, Prieto Jose Angel Arbesu, Armstrong Iain, Aubin Henri-Jean, Bachmann Michael, Bastus Nuria Bastida, Brotons Carlos, Burton Robyn, Cardoso Manuel, Colom Joan, Duprez Daniel, Gmel Gerrit, Gual Antoni, Kraus Ludwig, Kreutz Reinhold, Liira Helena, Manthey Jakob, Møller Lars, Okruhlica Ľubomír, Roerecke Michael, Scafato Emanuele, Schulte Bernd, Segura-Garcia Lidia, Shield Kevin David, Sierra Cristina, Vyshinskiy Konstantin, Wojnar Marcin, Zarco José
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
BMC Med. 2017 Sep 28;15(1):173. doi: 10.1186/s12916-017-0934-1.
Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.
A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.
Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.
The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.
危险及有害饮酒行为和高血压是全球非传染性疾病（NCD）过早死亡的主要风险因素。降低这两种风险因素的流行率被认为是实现全球非传染性疾病目标的途径。本研究旨在强调，在初级医疗保健中对高血压以及危险及有害饮酒行为进行筛查和干预，可极大地有助于实现非传染性疾病目标。
基于在五次筹备会议上展示和讨论的系统评价、荟萃分析、临床指南、实验研究及统计模型，召开了一次共识会议。具体而言，如果提高初级医疗保健机构中的筛查率和适当干预率，我们对五个欧洲大国的血压分布变化及潜在挽救生命数进行了建模。会议得出了在初级医疗保健机构中处理酒精性高血压的建议，并对其证据等级进行了分级。
对危险饮酒行为及酒精使用障碍进行筛查和适当干预可降低血压水平，但在欧洲初级医疗保健中缺乏对这些措施的实施。建议包括：（1）增加高血压筛查（证据等级：高）；（2）医生、护士及其他医疗保健专业人员对新发现的高血压患者增加危险及有害饮酒行为的筛查和简短建议（证据等级：高）；（3）对初级医疗保健中初发高血压患者的轻度酒精使用障碍进行临床管理（证据等级：中等）；（4）对血压控制不佳的高血压患者进行酒精使用情况筛查（证据等级：中等）。据估计，前三项措施每年可降低所研究国家的高血压患病率并挽救数百人的生命。
实施上述建议有助于减轻与高血压以及危险及有害饮酒行为相关的负担，从而有助于实现非传染性疾病目标。应在有评估的可控环境中实施，包括但不限于经济评估。
