Blood pressure and the new ACC/AHA hypertension guidelines
Blood pressure and the new ACC/AHA hypertension guidelines
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DOI：
10.1016/j.tcm.2019.05.003
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发表时间：
2020-04-01
影响因子：
9.3
通讯作者：
Adekola, Bemi
中科院分区：
文献类型：
--
作者：
Flack, John M.;Adekola, Bemi
ACC/AHA高血压指南几乎涵盖了高血压的诊断、评估、监测、继发原因以及药物和非药物治疗的所有方面。在任何需要有效血压测量的环境中，对精确测量血压所必需的策略给予了充分和适当的重视。血压测量过程中出现的大多数“错误”都会导致读数向上偏差，导致高血压的过度诊断，并且在那些已经接受药物治疗的患者中，低估了血压降低的真实程度，导致过度治疗。当血压持续 >= 130 和/或 >= 80 mm Hg 时，即可诊断为高血压。然而，大多数高血压在 130-139/80-89 mm Hg（1 期高血压）之间的患者不符合立即药物治疗的条件。该指南的一些建议开辟了新天地。当血压为 130-139/80-89 mm Hg（1 期高血压）且不存在高风险患者特征/合并症（包括 65 岁及以上、糖尿病、慢性肾病、已知心血管疾病）时，首次利用绝对心血管风险来确定高风险状态；当血压≥130/80毫米汞柱时，高危人群开始药物治疗。高危人群中的例外情况是对于未曾用药的个体进行二级中风预防，因为当血压>= 140/90 mm Hg 时开始药物治疗。当血压≥140/90毫米汞柱时，非高危个体将开始药物治疗。无论开始药物治疗的血压阈值如何，目标血压都是最低的
The ACC/AHA hypertension guidelines cover virtually all aspects of the diagnosis, evaluation, monitoring, secondary causes as well as drug and non-drug treatment of hypertension. Substantial and appropriate emphasis has been given to the strategies necessary for accurate measurement of blood pressure in any setting where valid blood pressure measurements are desired. Most "errors" made during blood pressure measurement bias readings upwards resulting in over-diagnosis of hypertension and, amongst those already on drug therapy, underestimating the true magnitude of blood pressure lowering resulting in over-treatment. Hypertension is diagnosed when blood pressure is consistently >= 130 and/or >= 80 mm Hg. However, the majority of patients with hypertension between 130-139/80-89 mm Hg (stage 1 hypertension) do not qualify for immediate drug therapy. The guideline breaks new ground with some of its recommendations. Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89 mm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP >= 130/80 mm Hg. The exception amongst high-risk individuals is for secondary stroke prevention in drug naive individuals as drug therapy is initiated when blood pressure >= 140/90 mm Hg. Non-high risk individuals will initiate drug therapy when BP is >= 140/90 mm Hg. Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally