从不同国际高血压治疗指南看老年及老老年高血压的治疗策略

<正>近年来,老年高血压发病率明显上升,但多达75%的人血压控制不能达标。不同的国际高血压治疗指南中,对老年尤其是老老年(年龄>80岁)人群高血压的治疗上存在分歧,可能导致在这个特定的群体血压控制达标率较低。     

老年高血压的诊断和治疗策略

<正>国内外研究表明,我国年龄>60岁老年人高血压的患病率为49%,≥80岁的老年人高血压患病率高达90%。但老年人高血压的治疗率及控制率较低,我国老年人高血压的治疗率和控制率分别为32.2%和7.6%,因此,积极开展老     

关注高龄高血压患者的血压管理问题

正高血压是心血管病的重要危险因素。据2013年统计,我国年龄≥80岁高龄老年人已超过2300万,并以年均100万以上速度增长,其中70%~90%患高血压[1]。2017AHA/ACC高血压指南在AHA年会上重新将高血压定义为≥130/80 mm Hg(1mm Hg=0.133kPa),但我国还需视具体国情而行。我们现针对年龄≥80岁高龄高血压患者的降     

妊娠期高血压的诊断和抗高血压治疗

无论是发达国家还是发展中国家 ,妊娠期高血压(hypertensioninpregnancy)疾患是导致孕妇和围生儿发病和死亡的主要原因之一[1],约有 15%妊娠相关的死因是由于妊娠期高血压所致。流行病学资料表明在我国目前约有10 %左右的孕妇患有高血压 ;在 1990年至 1999年期间 ,美国先兆子痫的发病率增加了 40 % ;妊娠期高血压已成为一个世界性的重要公共卫生问题。但是 ,目前妊娠期高血压的药物治疗在学术界存在较大争议 ,如降压药物的应用时机 ,降压达到何种水平 ,降压药物对母儿结局的影响以及降压药物的不良反应等[1 4]。本文结合近年来国内外的一些…     

阿托伐他汀对老年高血压患者动脉弹性和踝臂指数的影响

目的探讨阿托伐他汀对老年高血压患者动脉弹性和踝臂指数(ABI)的短期影响。方法选择87例老年高血压患者,随机分为对照组42例和阿托伐他汀组(治疗组)45例,治疗3个月。观察治疗前后,肱动脉脉压、脉搏波传导速度(PWV)、大、小动脉弹性指数(C1和C2)和ABI的变化。结果对照组治疗前后,各指标均无显著改变。治疗组治疗后与治疗前比较,脉压降低(4.09±8.58)mmHg(1mmHg=0.133kPa),PWV下降(1.6±3.15)m/s,C2增高(0.42±0.97)ml/mmHg×100,ABI增高(0.08±0.16),差异有统计学意义(P<0.05,P<0.01)。结论阿托伐他汀可改善高血压患者C2和PWV、缩小脉压,同时对外周血管疾病也有改善作用。     

高血压治疗的现代观念

过去7年,相继发表了9项重要高血压临床试验：高血压的合理治疗（hypertension optimal treatment,HOT）、卡托普利预防试验（captopril prevention project,CAPPP）、瑞典老人高血压试验-2（Swedish trial in old patients with hypertension 2,STOP-2）、抗高血压药和调血脂药预防心脏病发作试验（antihypertensive and lipid-lowering treatment to prevent heart attack trial,ALLHAT）、北欧地尔硫（艹卓）试验（Nordic diltiazem study,NORDIL）、高血压治疗目标（intervention as a goal in hypertension treatment,INSIGHT）、氯沙坦对高血压试验终点的干预（losartan intervention for endpoint reduction in hypertension study,LIFE）、缬沙坦长期使用评估（valsartan antihypertensive long-term use evaluation,VALUE）、英国人和斯堪的那维亚人心脏试验-降血压篇（Anglo-Scandinavian cardiac outcomes trial-blood pressure lowering arm,ASCOT-BPLA）,使高血压治疗观念和策略发生日新月异变化.可概括为早期、快速、平稳、联合、综合.[第一段]     

接受治疗的高血压老人自测血压与诊室血压的预后价值比较[英]／Bobrie G…／／JAMA

如众所知，与诊室所测血压相比，家中自测血压更为准确且更具可复测性。然而关于两者的预后价值对照尚未见报道。本文意就接受降压药治疗的高血压老人诊室所测血压与家中自测血压的预后价值进行了比较。     

抗高血压药物治疗的进展

岭南心血管病学术研讨会及近年来冠心病和心血管防治进展学习班于 2 0 0 2年 4月 4～ 8日在广州市广东大夏举行。来自广东、广西、湖南、海南及其他中南各省、市、自治区从事心血管疾病专业人员共 10 0 0余人参加。会议邀请了国内外著名的心脏病专家十余人进行了专题讲座 ,深得听众好评。本刊特将专家讲稿汇集刊登 ,以满足广大读者要求。     

北京城乡老年人高血压现状调查

目的了解北京城乡老年人高血压的现状。方法采用分层整群随机抽样方法,选取北京地区年龄≥60岁的老年人2277例进行血压测量及相关资料的收集。结果 2277例老年人中,高血压患者1275例,北京地区老年人高血压患病率为56.0%,知晓率为57.7%,治疗率为56.2%,治疗后控制率为36.4%。结论高血压患病率高,但知晓率、治疗率和控制率较低,必须积极采取有效的措施以降低高血压的患病率,提高知晓率、治疗率和控制率。     

Diagnosis and treatment of refractory sprue

Celiac disease is a gluten-sensitive enteropathy characterized by villous atrophy that is reversed by gluten withdrawal. A minority of these patients is resistant to a gluten-free diet or, after a period of remission, they experience relapse despite continued adherence to treatment, which is called unclassified sprue or refractory sprue.The prognosis of refractory sprue may be poor: patients may die of severe malabsorption or from the development of an enteropathy-associated T-cell lymphoma. We report a 72-year-old-woman with a diagnosis of refractory sprue who responded well to treatment with corticosteroids and a gluten-free diet.     

高血压病诊断治疗的最新进展

当今 ,心脑血管疾病是我国人群死亡的重要原因之一 ,其在各种死亡原因中的百分比由 195 7年的 10 0 %上升到1997年的 39 4%。心脑血管病中主要致残、致死的原因是脑卒中、各型冠心病、心力衰竭等 ,而高血压病在上述临床病征的发病机制方面占有十分重要的地位。因此 ,高血压的防治一直是全球医学界的重要研究课题。 2 0世纪的 5 0年代至世纪末 ,高血压的研究取得了显著的进展 ;长达数十年的流行病学及各种大型临床试验的研究进一步阐明了发生高血压的各种危险因素及高血压与冠心病、糖尿病等的相互影响 ,高血压对靶器官特别是心、肾、脑的损…     

顽固性高血压的诊治进展

高血压是全球主要的公共卫生问题之一。我国成人高血压患者约有1.6亿[1],而其中8%～15%为顽固性高血压。顽固性高血压的定义:经使用包括利尿剂在内的、足量且合理的3种或以上抗高血压药物治疗,血压仍未能控制在140     

肺动脉高压的诊断与治疗

[编者按] 肺动脉高压是一组经肺循环阻力增高为主要特征的异源性疾病,近十余年来,国外在此领域取得了突飞猛进的发展,包括发病机制、病理生理机制、分类、诊断方法、严重程度的判断及治疗手段等,并制定了<肺动脉高压诊断和治疗指南>.我国虽然在此方面的研究起步较晚,起点水平较低,但通过中华医学会和各级医生的不懈努力,近年来该领域的研究也有了很大进展,本刊已在2007年第9期发表了数篇国内学者撰写的述评和专题笔谈[1-6].     

Diagnosis and treatment of low-renin hypertension

Plasma renin levels can be used to classify hypertension. A significant proportion of hypertensive individuals display a low-renin profile and thus low-renin hypertension (LRH) requires appropriate diagnosis and treatment. LRH includes essential, secondary and genetic forms, the most common of which are low-renin essential hypertension and primary aldosteronism. Several studies have investigated the relationship between PRA status and clinical response to different antihypertensive therapies. The present review will discuss the differential diagnosis of LRH subtypes and the most appropriate treatment options based on the pathophysiological background of this condition.     

Diagnosis and treatment of portal hypertension

Prevention of the first variceal haemorrhage should start when the patients have developed medium-sized to large varices. Non-selective beta-blockers and band ligation are equally effective in preventing the first bleeding episode. Rubber band ligation is the first choice for patients with contraindications or intolerance to beta-blockers.

Treatment of acute bleeding should aim at controlling bleeding and preventing early rebleeding and complications, especially infections. Combined endoscopic (band ligation or sclerotherapy) and pharmacological treatment with vasoactive drugs can control bleeding in up to 90% of patients. Antibiotic prophylaxis is an integral part of the treatment of acute variceal haemorrhage, and must be started as soon as possible. Emergency transjugular intrahepatic portosystemic stent shunt (TIPS) is the standard rescue therapy for patients failing combined endoscopic and pharmacological treatment.

All patients who survive a variceal bleed should be treated with beta-blockers or band ligation to prevent rebleeding. All patients in whom bleeding cannot be controlled or who continue to rebleed can be treated with salvage TIPS or, in selected cases, with surgical shunts. Liver transplantation should be considered for patients with severe liver insufficiency in which first-line treatments fail.     

Diagnosis and treatment of portal hypertension

Major progress has been made in the area of diagnosis and treatment of portal hypertension. Multi-detector row computed tomography (MD-CT) enabled the revelation of the precise overview of portal hemodynamics and was applied into the decision of therapeutic strategies. A noninvasive liver stiffness measurement device, transient elastography, is expected to be applied in the prediction of existence of esophageal varices. Balloon-occluded retrograde transvenous obliteration (B-RTO) is performed mainly in Japan to eradiate the fundic varices and high eradiation rate and low recurrence rate are reported. Partial splenic embolization (PSE) has been performed to improve hypersplenism without serious side-effect and excellent result is reported. Angiotensin receptor blockers (ARBs) are promising drugs for its portal hypotensive effect and antifibrotic effect and more investigation is necessary. Anti-fibrotic therapy, including autologous bone marrow therapy, has the possibility to improve not only liver fibrosis but also portal hypertension.