高血压

吕师傅，52岁，发现高血压1年，也一直吃着降压药，但是血压总是乱跳，时高时低，今日门诊来看。 详细询问后得知，吕师傅吃过好几种降压药：硝苯地平片、卡托普利、尼群地平等等。 王医生：那您一天吃几次？ 吕师傅：大多数一次，有时候量高了，再加一次…

Thomas Unger, Claudio Borghi, Fadi Charchar, Nadia A. Khan, Neil R. Poulter,Dorairaj Prabhakaran, Agustin Ramirez, Markus Schlaich, George S. Stergiou,Maciej Tomaszewski, Richard D. Wainford, Bryan Williams, Aletta E. Schutte

The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019)

Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children

The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)
Authors/Task Force Members: Bryan Williams* (ESC Chairperson) (UK),Giuseppe Mancia* (ESH Chairperson) (Italy), Wilko Spiering (The Netherlands),Enrico Agabiti Rosei (Italy), Michel Azizi (France), Michel Burnier (Switzerland),Denis L. Clement (Belgium), Antonio Coca (Spain), Giovanni de Simone (Italy),Anna Dominiczak (UK), Thomas Kahan (Sweden), Felix Mahfoud (Germany),Josep Redon (Spain), Luis Ruilope (Spain), Alberto Zanchetti† (Italy), Mary Kerins(Ireland), Sverre E. Kjeldsen (Norway), Reinhold Kreutz (Germany),Stephane Laurent (France), Gregory Y. H. Lip (UK), Richard McManus (UK),Krzysztof Narkiewicz (Poland), Frank Ruschitzka (Switzerland),Roland E. Schmieder (Germany), Evgeny Shlyakhto (Russia), Costas Tsioufis (Greece), Victor Aboyans (France), and Ileana Desormais (France)

The standardized techniques of blood pressure (BP) measurement in the clinic are emphasized and it is
recommended to replace the mercury sphygmomanometer by a non-mercury sphygmomanometer. Out-of-office
BP measurement using home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM) and even automated
office BP (AOBP) are recommended to correctly measure the patient’s genuine BP. Hypertension (HTN) treatment
should be individualized based on cardiovascular (CV) risk and the level of BP. Based on the recent clinical study
data proving benefits of intensive BP lowering in the high risk patients, the revised guideline recommends the
more intensive BP lowering in high risk patients including the elderly population. Lifestyle modifications, mostly low
salt diet and weight reduction, are strongly recommended in the population with elevated BP and prehypertension
and all hypertensive patients. In patients with BP higher than 160/100 mmHg or more than 20/10 mmHg above the
target BP, two drugs can be prescribed in combination to maximize the antihypertensive effect and to achieve
rapid BP control. Especially, single pill combination drugs have multiple benefits, including maximizing reduction of
BP, minimizing adverse effects, increasing adherence, and preventing cardiovascular disease (CVD) and target organ
damage.

The Korean Society of Hypertension guideline defines hypertension as systolic blood pressure ≥ 140 mmHg or
diastolic blood pressure ≥ 90 mmHg, where the effectiveness of pharmacological treatment has been established. It
is confirmed that higher blood pressure levels are associated with increased risk of cardiovascular disease and
mortality also in the Korean population. About one third of Korean adults aged 30 years or older are estimated to
have hypertension, and the prevalence of hypertension gradually increases as the age increases. The awareness,
treatment, and control rates of hypertension are generally improving in Korea, but more efforts are required to
increase awareness and treatment among younger patients with hypertension and to improve lifestyle modification
compliance at all ages. More studies are required to determine the magnitude and impact of white coat
hypertension and masked hypertension in the Korean population.

2017 ACC/AHA/AAPA/ABC/ACPM/
AGS/APhA/ASH/ASPC/NMA/PCNA
Guideline for the Prevention,
Detection, Evaluation, and Management
of High Blood Pressure in Adults
A Report of the American College of Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines

Treatment of hypertension improves cardiovascular, renal, and cerebrovascular outcomes. However, the benefit oftreatment may be different according to the patients’ characteristics. Additionally, the target blood pressure or initial drug choice should be customized according to the special conditions of the hypertensive patients. In this part III, we reviewed previous data and presented recommendations for some special populations such as diabetes mellitus, chronic kidney disease, elderly people, and cardio-cerebrovascular disease.

沙坦类降压药，因其自身的各种优势，在所有降压药种，应该是医生和患者都比较喜欢的一类药物。 沙坦类降压药不但降压平稳，而且没有普利类降压药常见的咳嗽；没有地坪类常见的心悸、水肿、面红；没有利尿剂的电解质紊乱；没有洛尔类的引起心跳慢&#8230…