协和医学杂志

2019, v.10(02) 103-107

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面对新的高血压诊断标准,我国卒中预防策略会改变吗?
Will the Strategies of Stroke Prevention Change with the New Diagnostic Standard of Hypertension?

钟迪;吴波;
ZHONG Di;WU Bo;Department of Neurology,West China Hospital,Sichuan University;

摘要(Abstract):

高血压是卒中最重要的危险因素。我国目前高血压控制情况不佳,高血压知晓率、治疗率和控制率均较低。2017年,美国成人高血压预防、监测、评估和管理指南更新了高血压诊断标准,将高血压阈值定为130/80 mm Hg(1 mm Hg=0. 133 kPa),并在该标准下制定了新的高血压治疗目标和管理策略。该指南主要基于收缩压干预试验(Systolic Blood Pressure Intervention Trial,SPRINT)研究结果,即与标准降压治疗相比,强化降压治疗可降低心血管事件发生率和全因死亡率。但同时,这一标准使高血压患者的数量大幅增加,且将影响大部分人群的治疗措施,包括老年人群和衰弱人群,在增加经济负担的同时增加了特殊人群的不良反应,不利于高血压防控和个体化治疗。故在此高血压标准下,结合现有证据,我国卒中预防策略尤其是一级预防应有所变化。
Hypertension is the most important risk factor for stroke,which is not well controlled in China.The rates of awareness,treatment,and control of hypertension are low. 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 redefines hypertension,setting the threshold of hypertension at 130/80 mm Hg( 1 mm Hg= 0. 133 kPa). By this standard,new therapeutic targets and management strategies for hypertension were formulated. The guideline is based on the results of Systolic Blood Pressure Intervention Trial( SPRINT),which indicate that intensive antihypertensive therapy reduces the incidence of cardiovascular events and all-cause mortality compared with the standard blood pressure control. But at the same time,this standard increases the number of patients with hypertension and affects the treatment measures in most people including the elderly and the weakened population. It increases the economic burden while increasing the adverse reactions in special populations,which is not conductive to the prevention and individualized treatment of hypertension. Therefore,by this hypertension standard,according to the existing medical evidence,it is suggested that strategies of stroke prevention,especially primary prevention,should be changed in China.

关键词(KeyWords): 高血压;指南;卒中,预防;抗高血压治疗
hypertension;guideline;stroke,prevention;antihypertension therapy

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81671146,81870937)

作者(Author): 钟迪;吴波;
ZHONG Di;WU Bo;Department of Neurology,West China Hospital,Sichuan University;

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