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药学服务进行药物治疗管理对高血压患者血压及心血管风险的影响:一项系统评价、Meta分析和Meta回归分析

Effect of Medication Therapy Management by Pharmaceutical Care on Blood Pressure and Cardiovascular Risk in Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression.

作者信息

de Souza Cazarim Maurilio, Cruz-Cazarim Estael Luzia Coelho, Boyd Kathleen, Wu Olivia, Nunes Altacílio Aparecido

机构信息

Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora 36036-900, MG, Brazil.

Department of Pharmaceutical Service, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, SP, Brazil.

出版信息

Pharmaceuticals (Basel). 2023 Jun 6;16(6):845. doi: 10.3390/ph16060845.

Abstract

Medication therapy management by pharmaceutical care (MTM-PC) has been shown to improve the effectiveness of antihypertensive treatments. The aim was to answer the question: what are the MTM-PC models and their impact on hypertensive patients' outcomes? This is a systematic review with meta-analysis. The search strategies were run on 27 September 2022 in the following databases: PubMed, EMBASE, Scopus, LILACs, Central Cochrane Library, Web of Science; and International Pharmaceutical Abstracts. The quality and bias risk was assessed by the Downs and Black instrument. Forty-one studies met the eligibility criteria and were included, Kappa = 0.86; 95% CI, 0.66-1.0; ( < 0.001). Twenty-seven studies (65.9%) had MTM-PC models outlined by the clinical team, showing as characteristics the mean of 10.0 ± 10.7 months of follow-up of hypertensive patients, with 7.7 ± 4.9 consultations. Instruments to assess the quality of life measured the enhancement by 13.4 ± 10.7% ( = 0.047). The findings of the meta-analysis show a mean reduction of -7.71 (95% CI, -10.93 to -4.48) and -3.66 (95% CI, -5.51 to -1.80), ( < 0.001) in mmHg systolic and diastolic pressures, respectively. Cardiovascular relative risk (RR) over ten years was 0.561 (95% CI, 0.422 to 0.742) and RR = 0.570 (95% CI, 0.431 to 0.750), considering homogeneous studies, I² = 0%. This study shows the prevalence of MTM-PC models outlined by the clinical team, in which there are differences according to the models in reducing blood pressure and cardiovascular risk over ten years with the improvement in quality of life.

摘要

药物治疗管理(MTM)的药学服务模式(MTM-PC)已被证明可提高抗高血压治疗的效果。本研究旨在回答以下问题:MTM-PC模式有哪些,以及它们对高血压患者的治疗效果有何影响?这是一项带有荟萃分析的系统评价。检索策略于2022年9月27日在以下数据库中进行:PubMed、EMBASE、Scopus、LILACs、Cochrane中央对照试验注册库、Web of Science以及国际药学文摘数据库。采用唐斯和布莱克工具评估研究质量和偏倚风险。41项研究符合纳入标准并被纳入分析,Kappa = 0.86;95%置信区间为0.66 - 1.0;(P < 0.001)。27项研究(65.9%)采用了临床团队制定的MTM-PC模式,其特点是高血压患者的平均随访时间为10.0 ± 10.7个月,共进行7.7 ± 4.9次咨询。评估生活质量的工具显示生活质量提高了13.4 ± 10.7%(P = 0.047)。荟萃分析结果显示,收缩压和舒张压平均分别降低了-7.71(95%置信区间为-10.93至-4.48)和-3.66(95%置信区间为-5.51至-1.80),(P < 0.001)。考虑同质性研究,I² = 0%,十年心血管疾病相对风险(RR)为0.561(95%置信区间为0.422至0.742),RR = 0.570(95%置信区间为0.431至0.750)。本研究显示了临床团队制定的MTM-PC模式的普遍性,不同模式在降低血压和十年心血管风险以及改善生活质量方面存在差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adde/10302324/32a5cb611bbb/pharmaceuticals-16-00845-g001.jpg

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