高血压病治疗的最新策略——高举明灯,控制总危险

原发性高血压为全球高发疾病,是各种心脑血管疾病的主要危险因素。积极有效地治疗高血压病人对于心脑血管疾病的防治至关重要。最新的高血压治疗策略特别强调根据诊所血压值、动态血压值、合并的心血管危险因素、靶器官损害、相关的心血管及肾脏疾病等评价病人的总危险。分为低危、中危、高危、极高危。治疗的首要目标是降低长期的心血管总危险。需要降压达标、控制所有心血管危险因素。血压至少需降至140/90mmHg以下,如果能够耐受可以进一步降低。对于糖尿病及其它高危、极高危病人血压应尽量降至130/80mmHg以下。主张及早考虑联合2种或多种降压药物。另外所有高血压病人均应积极评价是否有指征使用他汀类降脂药以及阿司匹林等抗血小板药物。

New Strategy for Management of Arterial Hypertension-Control the Total Cardiovascular Risk

Hypertension is a global common disease and a leading cause of cardiovascular mortality and morbidity in the western countries,as well as in China now.Strategy for the management of arterial hypertension is the most important thing in our public health.What`s new the strategy for hypertension? First,estimation of total cardiovascular risk by measuring the office BP,ambulatory BP,coexistence of cardiovascular risk factors,target organ damage and associated cardiovascular and renal diseases.Categorization of total risk as low,moderate,high,and very high risk.Secondly,the primary goal of treatment is to achieve maximum reduction in the long-term total risk of cardiovascular events.This requires treatment of the raised BP per se as well as of all associated reversible risk factors.BP should be reduced to at least below 140/90 mm Hg,and to lower levels if tolerated,and at least <130/80mm Hg in diabetes,and in high or very high risk patients.Combination treatment of 2 or 3 low dose different antihypertensives to reach the target BP level and intervention against all reversible risk factors is essential for total risk reduction.And statin,aspirin ot other antiplatelet drugs should be considered for all patients.