2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension
2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension
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DOI：
10.1097/01.hjh.0000084751-37215.d2
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发表时间：
2003-11-01
影响因子：
4.9
通讯作者：
Whitworth, J
中科院分区：
文献类型：
--
作者：
Afridi, I;Canny, J;Whitworth, J
目的高血压占目前全球疾病负担的4.5%，在许多发展中国家和发达国家一样普遍。在整个血压范围内，由血压引起的心血管风险持续上升。各国在管理高血压方面的能力差异很大，但在世界范围内，大多数确诊的高血压患者没有得到充分的控制。这份声明阐述了确定总体心血管风险，以建立开始治疗的阈值和治疗目标，非药物和药物治疗的适当治疗策略，以及治疗的成本效益。结论自1999年发布WHO/ISH高血压管理指南以来，已有更多证据支持即使是“低风险”患者的收缩压阈值为140毫米汞柱。在高危患者中，有证据表明阈值较低。建议所有人改变生活方式。有证据表明，特定的药物对具有特别令人信服的适应症的患者有好处，而单一疗法对大多数患者是不够的。对于没有令人信服的特定药物类别适应症的患者，根据比较试验数据、可获得性和成本，应该考虑开始治疗时使用低剂量的利尿剂。在大多数地方，噻嗪类利尿剂是最便宜的选择，因此也是最具成本效益的，但对于令人信服的适应症来说，其他类别提供了额外的好处，即使更昂贵，它们可能更具成本效益。在从治疗中获得巨大好处的高风险患者中，昂贵的药物可能是具有成本效益的，但对于低风险患者，除非药物便宜，否则治疗可能不具有成本效益。(C)2003年，里平科特·威廉姆斯·威尔金斯。
Objective Hypertension is estimated to cause 4.5% of current global disease burden and is as prevalent in many developing countries, as in the developed world. Blood pressure-induced cardiovascular risk rises continuously across the whole blood pressure range. Countries vary widely in capacity for management of hypertension, but worldwide the majority of diagnosed hypertensives are inadequately controlled. This statement addresses the ascertainment of overall cardiovascular risk to establish thresholds for initiation and goals of treatment, appropriate treatment strategies for non-drug and drug therapies, and cost-effectiveness of treatment.Conclusions Since publication of the WHO/ISH Guidelines for the Management of Hypertension in 1999, more evidence has become available to support a systolic blood pressure threshold of 140 mmHg for even 'low-risk' patients. In high-risk patients there is evidence for lower thresholds. Lifestyle modification is recommended for all individuals. There is evidence that specific agents have benefits for patients with particular compelling indications, and that monotherapy is inadequate for the majority of patients. For patients without a compelling indication for a particular drug class, on the basis of comparative trial data, availability, and cost, a low dose of diuretic should be considered for initiation of therapy. In most places a thiazide diuretic is the cheapest option and thus most cost effective, but for compelling indications where other classes provide additional benefits, even if more expensive, they may be more cost effective. In high-risk patients who attain large benefits from treatment, expensive drugs may be cost effective, but in low-risk patients treatment may not be cost-effective unless the drugs are cheap. (C) 2003 Lippincott Williams Wilkins.