В статье представлен сравнительный анализ 4 англоязычных рекомендаций профессиональных сообществ за 2013 г. по вопросам используемых методик составления рекомендаций; уровней артериального давления – АД (начального, порогового и целевого); групп препаратов 1-го ряда и схем лечения. Выводы. Разные методики составления рекомендаций и применение экспертных мнений в условиях отсутствия доказательств приводят к определенным различиям в рекомендациях. На сегодня недостаточно согласованы вопросы начального и целевого уровня АД у пожилых пациентов, использования b-адреноблокаторов в качестве группы препаратов 1-го ряда, в рекомендациях представлены разные схемы лечения.
The article presents the comparison study of 4 English-language recommendations of professional communities during 2013 year concerning the methods used for formulating recommendations; blood pressure levels – BP (primary, threshold and target); the group of primary agents and the treatment regimens. Conclusions. Different methods for formulating recommendations and the use of expert opinions in the absence of the evidences can lead to certain differences in the recommendations. It is not enough being agreed upon the questions concerning the primary and target BP level in elderly patients, the use of b-blockers as the group of primary agents, nowadays and the recommendations show the different treatment regimens.
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1. 2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hypertension 2013; 31: 1281–357.
2. An Effective Approach to High Blood Pressure Control: American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J Am Coll Cardiol 2014; 63 (12): 1230–8.
3. Clinical Practice Guidelines for the Management of Hypertension in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertension 2014; 32 (1): 3–15.
4. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) JAMA. doi:10.1001/jama.2013.284427 Published online December 18, 2013.
5. Martin S, Boucher M, Wright J M, Saini V. Mild hypertension in people at low risk. BMJ 2014; 349: g5432.
6. Tricoci P, Allen JM, Kramer J et al. Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA 2009; 301: 831–41.
7. Andreeva N.S., Rebrova O.Iu., Zorin N.A. i dr. Sistemy otsenki dostovernosti nauchnykh dokazatel'stv i ubeditel'nosti rekomendatsii: sravnitel'naia kharakteristika i perspektivy unifikatsii. Meditsinskie tekhnologii: otsenka i vybor. 2012; 4: 10–24. [in Russian]
8. Samorodskaia I.V. Smogut li dokazatel'stva vliiat' na formirovanie standartov okazaniia meditsinskoi pomoshchi? Problemy standartizatsii v zdravookhranenii. 2007; 2: 22–35. [in Russian]
9. Lenzer J. Why we can't trust clinical guidelines. BMJ 2013; 346: f3830.
10. Crane M. Physician frustration grows, income falls but a ray of hope. Medscape Business of Medicine. April 24, 2012. http://www.medscape.com/viewarticle/761870 Accessed February 4, 2014.
Авторы
И.В.Самородская*, С.А.Бойцов
ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 117334, Россия, Москва, Петроверигский пер., д. 10
*samor2000@yandex.ru
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I.V.Samorodskaya*, S.A.Boitsov
The National Research Centre for Preventive Medicine of the Ministry of Health of the Russian Federation, 117334, Russian Federation, Moscow, Petroverigskii per., d. 10.
*samor2000@yandex.ru