如何采取精准治疗实现血压波动的有效控制

高血压是全球范围内心血管事件的最主要危险因素,达标降压是降低高血压患者心脑血管事件的主要措施,但降压治疗总是存在"残余风险"。本期"学术争鸣"栏目《如何采取精准治疗实现血压波动的有效控制》中,陈伟伟教授等阐述了精准血压控制的重要性,临床医生应更多地了解高血压表型的多样性,做到精准地控制高血压,而非局限于目前所实行的诊室血压达标。同时要更多地关注并存危险因素的控制,才能更好地降低残余风险。     

高血压病是心血管病危险综合征的重要组成部分

近年认识到心血管总负荷对发生心血管事件的重要性以及控制高血压同时存在的心血管病危险因素的绝对益处,提出应视高血压病为心血管病危险综合征的一个组成成分。现着重复习心血管病危险综合征中高血压患者降压治疗的益处。降压药物的合理应用:治疗原则,降压目的,目标血压,药物选择。降压药物联合治疗,以及高血压合并其他心脑血管病时的药物选择,包括脑血管病、糖尿病、冠心病、心力衰竭、肾脏损害及相关危险因素,伴随疾病的治疗。     

充分发挥单片复方制剂在降压治疗中的优势作用

高血压是心血管系统最重要的危险因素之一,将血压持久地控制在目标值以下可以明显减少高血压所致的靶器官损害与不良心血管事件。药物治疗是降压达标的主要手段,合理的联合用药则是提高血压达标率、改善患者远期预后的核心策略。单片复方制剂     

高血压合并糖尿病患者血压管理策略

高血压和糖尿病是心血管病的重要危险因素,二者并存的心血管危害性更大。我国是高血压合并糖尿病及卒中高发的国家,降压达标是降低此类患者心血管事件的关键,严格的血压目标值更有利于降低卒中的发病率;在强调改善生活方式的基础上,肾素—血管紧张素系统阻滞剂(RASI)或以RASI为基础的联合治疗是优选的降压方案;干预高血压和高血糖的同时,还应强调全面管理患者并存的其他心血管病危险因素、靶器官损伤和临床疾病,以最大限度降低患者的心血管病患病率和病死率。     

规范应用降压药,积极防控高血压

<正>高血压是最为重要的心血管病危险因素之一。近30年来,国内外先后完成了数十项大型随机临床试验,证实积极合理的降压治疗有助于大幅降低心血管事件风险。正因如此,降压达标已成为防治心血管疾病的核心策略。目前,我国高血压的防治现状仍不尽如人意,高血压患者的诊断率、治疗率、达标率仍处于较低水平。虽然改善生活方式是预防和治疗高血压的重要举措,但多数患者仍需要降压药物治疗才能使血压得到有效控制,因此合理应用降压药物是提高降     

降压联合他汀——高血压药物治疗的新策略

高血压是心血管系统的常见疾病之一,是冠心病、心力衰竭、慢性肾功能不全、脑卒中等心脑肾疾病的主要危险因素之一。近年研究发现在高血压患者合并血脂正常或轻度异常中,在降压的基础上联合他汀治疗能使血压更易控制,降低心脑血管疾病风险,提示他汀类药物可能具有独立于降脂外的降压作用,现将近年相关研究进展综述如下。     

“心血管风险综合防控策略”成为糖尿病治疗趋势

糖尿病、高血压、肥胖等都是心血管的危险因素。糖尿病患者要防止心血管病发生，必须综合控制这些危险因素，尤其重视降压。近日在京召开的“ADVANCE研究国际专家研讨会”上，来自澳大利亚的Bruce Neal教授介绍了降压治疗对糖尿病患者降低心血管风险的益处。     

降低高血压和预防冠心病

有效降压是高血压患者获益的基石,降压达标是高血压治疗的核心.降压治疗的目的 不仅仅是降低血压水平,其最终的目的 是有效降低靶器官损害的危险性,进而减少心血管终点事件的发生.循证医学证实了选择血管紧张素转换酶抑制剂+钙离子拮抗剂优化联合降压治疗方案对降压达标以及降低冠心病的发生率、病死率具有更明显的优势.     

高血压患者胆固醇管理临床指导建议

近年来我国的高血压患病率呈快速增长趋势,据估计2006年全国高血压患病人数已达2亿~[1].高血压治疗的最终目的是最大程度地减少心脑血管事件~[2].降压临床治疗试验已经充分证明,长期有效地降低和控制血压能显著减少高血压患者的心血管危险,但是仅仅依靠控制血压水平,高血压患者仍存在较高的残余心血管危险,尤其是冠心病事件~[3].近年来在我国一些大城市,虽然出血性卒中发病率已呈下降趋势,而缺血性心血管病(包括冠心病和缺血性卒中)的发病率仍在上升~[4].为了更大程度地减少高血压患者心脑血管病事件,尤其是缺血性心血管病事件,必须调整在高血压患者中单纯降低血压的治疗策略.     

原发性高血压治疗的新见解和新方法:基于冠心病危险因素分析、血流动力学特点、生活质量、高血压分型选择治疗药物

预防高血压的心血管并发症特别是冠心病,是降压治疗的一大目标。本文着重探讨各种降压药物对冠心病危险因素的影响,提请人们给予应有的重视。     

The Effectiveness of Community Health Workers for CVD Prevention in LMIC

Community health workers (CHW) may be effective in tackling the burden of cardiovascular diseases in low- and middle-income countries (LMIC). This review examines whether CHWs can improve the identification and control of cardiovascular risk factors in LMIC. We searched for studies that used CHW as a basis for cardiovascular risk factor management. Our search yielded 11 articles that targeted cardiovascular risk factor assessment, hypertension, diabetes, smoking, diet and physical activity. There were 4 randomized controlled trials, 3 quasi-experimental studies, 3 cross-sectional studies, and 1 retrospective analysis. Eight studies reported positive results with CHW being able to effectively screen for cardiovascular risk factors, decrease systolic blood pressure, decrease fasting blood glucose, increase quit rates of smoking, decrease weight, and improve diet and physical activity. Our review demonstrates that CHW may be effective in helping tackle the burden of cardiovascular disease in LMIC.     

Managing Hypertension: State of the Science

Hypertension management is both routine and a challenge. Updated guidelines emphasize the need to achieve increasingly stringent blood pressure goals to reduce cardiovascular morbidity and mortality; however, the blood pressure of many patients who have been diagnosed with hypertension is not well controlled. Treating prehypertension nonpharmacologically may preempt the progression to hypertension, whereas early and aggressive management of hypertension with antihypertensive agents reduces short- and long-term cardiovascular risk. Treatment decisions should follow current guidelines while evaluating recently published clinical studies. When choosing between agents from different therapeutic classes or combining agents, physicians should consider current and targeted blood pressure levels, the patient's demographic profile, the presence or absence of compelling cardiovascular and metabolic indications, other comorbidities, and concurrent medication(s).     

Legacy benefits of blood glucose,blood pressure and lipid control in individuals with diabetes and cardiovascular disease: Time to overcome multifactorial therapeutic inertia?

Cardiovascular disease is a major cause of morbidity and mortality globally and the largest contributor to healthcare costs. There is good evidence that management of risk factors such as blood pressure, dyslipidaemia and glucose can lead to improved microvascular and macrovascular complications in individuals with type 2 diabetes mellitus. Legacy effect is a phenomenon used to describe the prolonged benefits of glucose, blood pressure or lipid control in individuals with cardiovascular disease, diabetes or in primary prevention of cardiovascular disease by early risk factor control. There is now also good quality evidence on the legacy benefits of multifactorial risk factor interventions on renal, cardiovascular and mortality outcomes. Despite this robust evidence, therapeutic inertia is widespread in the management of these risk factors in clinical practice.     

Poor control and management of cardiovascular risk factors among Albanian diabetic adult patients

BACKGROUND: Cardiovascular and metabolic risk factors represent potential targets for intervention. A good metabolic control, associated with control of blood pressure and cholesterol levels is proven to reduce the risk of cardiovascular disease among individuals with diabetes mellitus. OBJECTIVES: To examine 2004-2005 medical records of adults with previously diagnosed diabetes and to evaluate the fulfillment of diabetes guidelines treatment, for the metabolic control and management of cardiovascular risk factors. RESEARCH, DESIGN AND METHODS: We reviewed the data from the National Register of Diabetes (Tirana district), updated during this period. As guidelines we used the ADA 2006 Recommendations for metabolic control, HTA, lipid profile and aspirin therapy. RESULTS: We examined 7259 medical records. Only 14.58% of the patients had an HbA1c <7%. Central obesity was present in 39% of our patients. Overall, only 31.9% of our patients achieved the target for blood pressure (SBP<130 mmHg and DBP<80 mmHg). Two-third of our patients had total cholesterol >200 mg/dl. In total, only 5.5% of our patients attained recommended goals of cardiovascular risk factors for HbA1c, blood pressure and lipid profile. CONCLUSIONS: The follow-up of diabetic patients during the transient period in Albania is marked by a deterioration of diabetes metabolic control and poor management of cardiovascular risk factors. Further public health efforts are needed for better control of these risk factors among adults with diagnosed diabetes.     

Interventions in diabetic patients after myocardial infarction

Occurrence of a first acute myocardial infarction (AMI) is associated with further increase in risk of cardiovascular events. This risk is further increase is disproportionate in diabetics, who suffer from very high mortality short and long term after AMI. Factors responsible for the increased risk are only partially understood. Additional, properly designed, prospective epidemiological studies are needed for a better understanding of complicated diabetic macrovascular disease after the occurrence of the first event. These studies are also needed for designing interventional trials that target factors that carry the highest risk of new events. Published studies provide some insight into the issue of efficacy of blood pressure, cholesterol and blood glucose lowering strategies in the diabetic population. It remains unclear how important is the control of triglyceride concentration or other risk factors during various stages of recovery after AMI. The main reason is the lack of clinical trials. Evidence-based approach to patients with diabetes and AMI indicates the importance of tight control of cholesterol, blood pressure and blood glucose concentration. Although other risk factors have not been extensively studied, it is reasonable to assume that other major risk factors, such as hypertriglyceridemia, should be targeted as well. In the meantime, more data need to be collected from prospective epidemiological and interventional protocols, if better control over the cardiovascular risk in this high-risk population is to be achieved.     

2型糖尿病心血管疾病风险管理及利拉鲁肽的潜在优势

T2DM不仅存在高血糖,且往往合并肥胖、IR、血脂异常及高血压等危险因素,使其并发心血管疾病的风险大大增加.因此,理想的糖尿病管理不应仅局限于血糖的控制,更应全面管理各项危险因素.基于肠促胰素治疗的利拉鲁肽,在降低血糖的同时有控制体重,改善血脂,降低SBP等多重益处,为T2DM患者早期及长期的管理提供更理想的选择.本文就T2DM心血管疾病风险管理的重要性及利拉鲁肽在心血管保护效应方面的优势进行简要综述.     

Management of hypertension: Current state of the art and challenges

Hypertension is a major modifiable cardiovascular risk factor. Hypertension is also recognized as the most important risk factor for global disease burden. It is well established that a sustained reduction in blood pressure by drugs reduces the incidence of cardiovascular morbidity and mortality. In recent years, studies and new guidelines published for the management of hypertension. Awareness, treatment and control of hypertension are very poor, despite the new guidelines. We highlighted the management of hypertension in the light of current literature.     

Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk

In this review, we outline the rationale for targeting blood pressure and blood cholesterol lowering drug treatments to patients at high absolute cardiovascular risk, irrespective of their blood pressure or blood cholesterol levels. Because the specific levels of blood pressure and cholesterol are of little clinical relevance when considered in isolation from other risk factors, terms such as hypertension or hypercholesterolaemia have limited value. Separate management guidelines for raised blood pressure and blood cholesterol need to be replaced by integrated cardiovascular risk management guidelines, and absolute cardiovascular risk prediction scores should be used routinely. Since cardiovascular risk factors interact with each other, moderate reductions in several risk factors can be more effective than major reductions in one. An affordable daily pill combining low doses of various drugs could be useful for the many individuals with slightly abnormal cardiovascular risk factors.     

Role of community programs in controlling blood pressure

Despite more than 30 years of intense activity to improve control—and more recently prevention—high blood pressure continues to be a major public health problem. Evidence-based reviews have identified best practices and quality improvement strategies to address prevention and control. Since the 1970s, community-based programs have been instrumental in raising awareness, increasing knowledge, and promoting changes in health behavior to improve blood pressure control. Most of these programs have emphasized the use of partnerships and involvement of community residents in conducting screening and referral activities, implementing clinical practice guidelines, and increasing healthy eating and physical activity. Many also have used health care team approaches, including the use of trained community health workers to deliver targeted, culturally sensitive heart health education, particularly related to the prevention of cardiovascular disease risk factors in general and high blood pressure in particular. Increased focus on implementation of evidence-based lifestyle and clinical management strategies coupled with community-based approaches may help increase blood pressure control rates within communities.