Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

BMC Medicine

Guideline

Antoni Gual¹  Henri-Jean Aubin²  Daniel Duprez³  Bernd Schulte⁴  Ľubomír Okruhlica⁵  Michael Bachmann⁶  Marcin Wojnar⁷  Lars Møller⁸  José Zarco⁹  Manuel Cardoso^1,10  Helena Liira^1,11  Iain Armstrong^1,12  Robyn Burton^1,12  Cristina Sierra^1,13  Ludwig Kraus^1,14  Kevin David Shield^1,15  Michael Roerecke^1,16  Jürgen Rehm^1,17  Gerrit Gmel^1,18  Reinhold Kreutz^1,19  Jakob Manthey^2,20  Emanuele Scafato^2,21  Jose Angel Arbesu Prieto^2,22  Nuria Bastida Bastus^2,23  Lidia Segura-Garcia^2,24  Joan Colom^2,24  Konstantin Vyshinskiy^2,25  Carlos Brotons^2,26  Peter Anderson^2,27 

[1] Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain;CESP, University Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France;Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, USA;Centre for Interdisciplinary Addiction Research, Hamburg University, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany;Centrum pre Liecbu Drogovych Zavislosti, Bratislava, Slovakia;Copentown Healthcare Consultants, Cape Town, South Africa;Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland;Division of Noncommunicable Diseases through the Life Course, WHO Regional Office for Europe, Copenhagen, Denmark;Drugs Intervention Group, semFYC, Ibiza Primary Health Care Center, Madrid, Spain;General Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD), Lisbon, Portugal;General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia;University of Helsinki, Department of General Practice, and Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland;Health and Wellbeing Directorate, Public Health England, London, UK;Hypertension and Vascular Risk Unit, Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain;IFT Institut für Therapieforschung, Munich, Germany;Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden;Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada;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;Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;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;Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, Toronto, Canada;Department of Psychiatry, University of Toronto, Toronto, Canada;Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany;Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada;Implant Systems Group, National ICT Australia, Eveleigh, Australia;Faculty of Engineering, University of New South Wales, Sydney, Australia;Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany;Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany;National Observatory on Alcohol, National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy;Società Italiana di Alcologia (SIA), Italian Society of Alcohology, Bologna, Italy;Primary Care Center La Eria, Oviedo, Spain;Primary Care Spanish Society SEMERGEN, Madrid, Spain;Primary Health Center, Raval Nord, Barcelona, Spain;Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Barcelona, Spain;Research Institute on Addictions, Federal Medical Research Centre for Psychiatry and Narcology n.a. V. Serbsky, Moscow, Russia;Sardenya Primary Health Care Center, Biomedical Research Institute Sant Pau, Barcelona, Spain;Substance Use, Policy and Practice, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK;Alcohol and Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands;

关键词: Hypertension;    Blood pressure;    Alcohol use;    Primary healthcare;    Europe;    Screening;    Management;    Recommendations;   

DOI  :  10.1186/s12916-017-0934-1

 received in 2016-10-24, accepted in 2017-08-22,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundHazardous 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.MethodsA 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.ResultsScreening 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.ConclusionsThe 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.

【 授权许可】

CC BY   
© The Author(s). 2017