2010 Guidelines of the Taiwan Society of Cardiology for the Management of Hypertension
2010 Guidelines of the Taiwan Society of Cardiology for the Management of Hypertension
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DOI：
10.1016/s0929-6646(10)60120-9
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发表时间：
2010-10-01
影响因子：
3.2
通讯作者：
Chen, Jyh-Hong
中科院分区：
文献类型：
--
作者：
Chiang, Chern-En;Wang, Tzung-Dau;Chen, Jyh-Hong
高血压是动脉粥样硬化相关死亡率和发病率的最重要危险因素之一。在本文中，台湾心脏病学会高血压委员会提供了新的高血压管理指南，主要信息如下：（1）高血压的终身风险为90%（2）亚洲人的患病率增加和高血压导致心血管事件的相对风险均高于白人（3）近年来，台湾地区的控制率有显著的改善，男性由2.4%提高到21%，女性由5%提高到29%（1995-2002）（4）收缩压和舒张压（BP）≥ 130/80 mmHg是高危患者（如糖尿病患者）的治疗阈值，慢性肾脏疾病、中风、确诊的冠心病和冠心病等同疾病（颈动脉疾病、外周动脉疾病和腹主动脉瘤）（5）与办公室BP监测相比，动态和家庭BP监测与终末器官损伤更密切相关，并且与心血管事件的关系更强，但家庭监测的可行性使其成为更有吸引力的选择（6）隐匿性高血压患者比白大衣高血压患者有更高的心血管风险（7）应鼓励所有患者改变生活方式，包括以下六项S-ABCDE（限盐、限酒;减肥、戒烟;饮食适应;运动采用）（8）当需要药物治疗时，医生应考虑“PROCEED”（患者既往经验、风险因素、器官损伤、禁忌症或不利条件、专家或医生判断、费用或成本，（9）抗高血压药物的主要益处来自于降低血压本身，并且通常与所使用的药物无关，除了某些相关的心血管疾病可能有利于某些类别的药物。(10)有五大类药物：噻嗪类利尿剂; β受体阻滞剂、钙通道阻滞剂、血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）。这些药物中的任何一种都可以用作初始治疗，但β受体阻滞剂除外，β受体阻滞剂仅适用于心力衰竭、冠心病病史和肾上腺素能亢进状态的患者。(11)在减去安慰剂后，五种主要降压药物中的任何一种的标准剂量可以产生类似于10 mmHg的收缩压下降（10规则）和5 mmHg的舒张压下降（5规则）。(11)为了最佳控制BP，经常需要联合治疗，并且通过两种药物组合降低BP的量大约与以下的总和相同。如果其作用机制是独立的，则每种药物的降低（收缩压降低20 mmHg，舒张压降低10 mmHg），但ACEI和ARB联合用药除外。(13)ACEI或ARB加钙通道阻滞剂或利尿剂（A+C或A+D）是合理的两种药物组合，A+C+D是合理的三种药物组合，除非患者有特殊的β受体阻滞剂适应症。(14)强烈推荐在一片片剂中含有一种以上药物的单丸（固定剂量）组合，因为它们减少了药丸负担和成本，并提高了依从性。(15)高龄患者（≥ 80岁）应立即治疗，但应逐渐降低血压，莫尔谨慎。最后，这些指南不是强制性的;在高血压管理中，责任医生的决定仍然是最重要的。
Hypertension is one of the most important risk factors for atherosclerosis-related mortality and morbidity In this document, the Hypertension Committee of the Taiwan Society of Cardiology provides new guidelines for hypertension management The key messages are as follows (1) The life-time risk for hypertension is 90% (2) Both the increase in the prevalence rate and the relative risk of hypertension for causing cardiovascular events are higher in Asians than in Caucasians (3) The control rate has been improved significantly in Taiwan from 2.4% to 21% in men, and from 5% to 29% in women in recent years (1995-2002) (4) Systolic and diastolic blood pressure (BP) >= 130/80 mmHg are thresholds of treatment for high-risk patients, such as those with diabetes, chronic kidney disease, stroke, established coronary heart disease, and coronary heart disease equivalents (carotid artery disease, peripheral arterial disease, and abdominal aortic aneurysm) (5) Ambulatory and home BP monitoring correlate more closely with end-organ damage and have a stronger relationship with cardiovascular events than office BP monitoring, but the feasibility of home monitoring makes it a more attractive alternative (6) Patients with masked hypertension have higher cardiovascular risk than those with white-coat hypertension (7) Lifestyle changes should be encouraged in all patients, and include the following six items S-ABCDE (Salt restriction, Alcohol limitation; Body weight reduction, Cessation of smoking; Diet adaptation; Exercise adoption) (8) When pharmacological therapy is needed, physicians should consider "PROCEED" (Previous experience of patient, Risk factors, Organ damage, Contraindication or unfavorable conditions, Expert or doctor judgment, Expense or cost, Delivery and compliance) to decide the optimal treatment (9) The main benefits of antihypertensive agents are derived from lowering of BP per se, and are generally independent of the drugs being used, except that certain associated cardiovascular conditions might favor certain classes of drugs. (10) There are five major classes of drugs: thiazide diuretics; beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors (ACEIs); and angiotensin receptor blockers (ARBs). Any one of these can be used as the initial treatment, except for beta-blockers, which are only indicated in patients with heart failure, a history of coronary heart disease, and hyperadrenergic state. (11) A standard dose of any one of the five major classes of antihypertensive drugs can produce an similar to 10-mmHg, decrease in systolic BP (rule of 10) and a 5-mmHg decrease in diastolic BP (rule of 5), after placebo subtraction. (11) Combination therapy is frequently needed for optimal control of BP, and the amount of the decrease in BP by a two-drug combination is approximately the same as the sum of. the decrease by each individual drug (similar to 20 mmHg in systolic BP and 10 mmHg in diastolic BP) if their mechanisms of action are independent, with the exception of the combination of ACEIs and ARBs. (13) An ACEI or ARB plus a calcium channel blocker or a diuretic (A+C or A+D) are reasonable two-drug combinations, and A+C+D is a reasonable three-drug combination, unless patients have special indications for beta-blockers. (14) Single-pill (fixed-dose) combinations that contain more than one drug in a single tablet are highly recommended because they reduce pill burden and cost, and improve compliance.(15) Very elderly patients (>= 80 years) should be treated without delay, but BP should be reduced gradually and mor cautiously. Finally, these guidelines are not mandatory; the responsible physician's decision remains most important in hypertension management.