Eye Clinic as a Potential Site to Measure Blood Pressure.
Eye Clinic as a Potential Site to Measure Blood Pressure.
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眼科诊所是测量血压的潜在场所。
DOI：
10.1093/ajh/hpy161
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发表时间：
2018
影响因子：
3.2
通讯作者：
A. Adji
中科院分区：
文献类型：
--
作者：
A. Adji
高血压（BP）被普遍认为是心血管疾病和心脏相关残疾的最强可改变危险因素。 1 由于高血压的发病率、患病率和心血管并发症保持稳定，高血压的识别和治疗是目前干预的优先目标。 2 大约 45% 的 20 岁及以上的美国成年人患有高血压 3——即大约 1 亿人。尽管如此，2013年至2014年全国健康和营养检查调查的数据表明，这些血压升高的成年人中有16%不知道自己患有高血压。 4 目前，根据 2017 年美国心脏病学会/美国心脏协会 (ACC/AHA) 指南，在这 1 亿接受药物治疗的成人高血压患者中，只有约一半的血压水平得到控制。 3, 4 高血压控制不良会增加心血管疾病发病和死亡的风险。血压水平慢性进行性升高与心脏病风险增加相关，4 会导致心力衰竭和心绞痛，以及中风和痴呆。 5 自从弗雷明汉心脏研究认识到与年龄相关的动脉硬化引起的高收缩压 (SP) 是一个重要的心血管危险因素以来，高血压的治疗已经取得了长足的进步。 6 传统的诊室血压测量仍然是筛查、诊断和治疗血压升高的“金标准”。 7, 8 准确测量和记录诊室血压至关重要，需要遵循某些步骤以避免潜在错误。在 2-3 次单独就诊时获得的平均 2-3 个记录将最大限度地减少随机误差，并为血压水平的估计提供更准确的基础。 7 尽管诊所血压测量仍然是常规诊断工具，但诊室外血压测量越来越多地用于确认高血压的诊断。 7 建议进行诊室外测量以确认血压升高的诊断，并且可能有助于滴定降压药物。 7 动态血压监测目前被认为是最好的诊室外测量方法，9 特别是在筛查白大衣和明显高血压患者及其治疗管理方面。美国总统富兰克林·罗斯福因动脉压逐渐升高导致脑出血去世后，10 贝塞斯达（现）国家心肺血液研究所成立，负责协调心血管疾病及其与衰老相关的主要研究。罗斯福总统患病时，还没有有效的治疗高血压的药物，即使有，也经常出现副作用。治疗仅限于那些处于高血压晚期“恶性”阶段，且 SP 和舒张压 (DP) 逐渐升高并出现高血压脑病、急性心力衰竭或肾衰竭或中风的患者。退伍军人事务部试验结果公布后，治疗动脉血压升高的价值开始显现，最初针对严重高血压患者，11，然后是不太严重的高血压患者。 12 这些研究随后开展了老年人收缩期高血压计划，该计划证实了即使在 DP 正常或较低时治疗 SP 的重要性。 13 弗雷明汉心脏研究在了解动脉压如何随年龄变化方面发挥了重要作用。 14 现在已经确定，肱动脉 SP 从婴儿期到青春期逐渐增加，然后在 20 岁左右达到稳定水平，然后在一生中逐渐上升。 14 相反，DP 从出生到 50 岁左右逐渐上升，然后随着年龄的增长而下降……
High blood pressure (BP) is universally acknowledged as the strongest modifiable risk factor for cardiovascular disease and cardiac-related disability. 1 Recognition and treatment of hypertension are currently a priority target for intervention as the rate of its incidence, prevalence, and cardiovascular complications remains steady. 2 About 45% US adults aged 20 years and older have hypertension 3—ie, approximately 100 million people. Nonetheless, data from the National Health and Nutrition Examination Survey 2013 to 2014 indicate that 16% of these adults with elevated BP are not aware that they have hypertension. 4 Currently, only about half of those 100 million drug-treated adult hypertensives have their BP level controlled according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline. 3, 4 Poorly controlled hypertension increases the risk of cardiovascular morbidity and mortality. Chronic progressive rise of BP level is associated with increased risk of cardiac disease, 4 which leads to heart failure and angina, as well as to stroke and to dementia. 5 Management of high BP has come a long way since the Framingham Heart Study recognized high systolic pressure (SP) from age-related arterial stiffening as an important cardiovascular risk factor. 6 The conventional office BP measurement remains the “gold standard” for screening, diagnosis, and management of elevated BP. 7, 8 Accurate measurement and recording of office BP are vital and are required to follow certain steps in avoiding potential errors. An average of 2–3 recordings obtained on 2–3 separate visits to the clinic will minimize random error and provide a more accurate basis for estimation of BP level. 7 Although clinic BP measurement remains as a routine diagnostic tool, out-ofoffice BP measurement is increasingly used to confirm the diagnosis of hypertension. 7 Out-of-office measurements are recommended to confirm the diagnosis of elevated BP and may be useful for titration of BP-lowering medication. 7 Ambulatory blood pressure monitoring is currently regarded as the best out-of-office measurement method, 9 especially in screening out patients with white coat and marked hypertension and their treatment management. Following the death of the American President Franklin D. Roosevelt from brain hemorrhage due to progressive elevation of arterial pressure, 10 the (now) National Heart, Lung, and Blood Institute in Bethesda was established, where major studies on cardiovascular disease and its association with aging are coordinated. At the time of President Roosevelt’s illness, there were no effective drugs for treating elevated pressure, and those which did exist had frequent side effects. Treatment was reserved for those who were in the late “malignant” phase of hypertension with SP and diastolic pressure (DP) escalating upward to appearance of hypertensive encephalopathy, acute heart or renal failure, or stroke. The value of treating elevated arterial pressure began after the results of Veterans Affairs trials were published, initially in persons with severe, 11 and then with less severe hypertension. 12 These studies were then followed by the Systolic Hypertension in Elderly Program, which confirmed the importance of treating SP even when DP is normal or low. 13 The Framingham Heart Study played a major part in understanding how arterial pressure changes with age. 14 It is now established that brachial SP increases from infancy to adolescence, then plateaus at about 20 years of age, then rises progressively throughout life. 14 On the contrary, DP rises progressively from birth to around age 50 years, then falls with increasing age …
影响因子：
37.8
作者：
S. Franklin;William Gustin;N. Wong;M. Larson;M. Weber;W. Kannel;Daniel Levy
通讯作者：
S. Franklin;William Gustin;N. Wong;M. Larson;M. Weber;W. Kannel;Daniel Levy