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From the guide to update the changes in the blood pressure control target

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Tang Yiping

Deputy Chief Physician

In 2002, he graduated from the Department of Clinical Medicine of the Ministry of Medicine at Peking University; in 2011, he obtained a master’s degree in cardiovascular medicine at the Capital Medical University; and currently studying for PhD in Cardiovascular Department of Capital Medical University. He has worked at Beijing Zhen Hospital, Affiliated to the Capital Medical University since 2002. He has been engaged in cardiovascular hypertension for 15 years.

From 2017 to 2018, from the United States to Europe to China, new clinical research and data analysis have updated the high blood pressure guidelines of various countries. Among them, the most eye -catching and most discussion. The attention of the target value of hypertension is derived from the increase in the increase in blood pressure and the increase in the risk of cardiovascular disease. The fundamental purpose of our treatment of hypertension is to reduce the occurrence and death of cardiopathy and vascular complications that reduce hypertension. The total danger, if you want to achieve such a goal, you need to be achieved by controlling blood pressure to a certain level, then how much this certain blood pressure level is always an important issue for medical staff to discuss. Many years ago multiple studies prompts to drop The existence of the J -shaped curve and the release of the results of the ACCORD research have enabled the strengthening of antihypertensive therapy into the bottleneck. Research evidence and conclusions, these new evidence also promotes the update and rewriting of each guide.

The first is that the American Heart Association (AHA) announced the new American version of the high blood pressure guide at the 2017 annual meeting. The standard of hypertension diagnosis was defined as ≥130/80 mmHg, which was reduced by 10mmHg. The main basis was the result of Sprint research. Sprint Studies include 9,361 patients over the age of 50 from 102 clinical centers in the United States and Puerto. Elected standards: systolic blood pressure at 130-180 mmHg and include at least one other cardiovascular disease risk factors or high treatment of high treatment high. Patients with blood pressure, randomly allocate patients to the enhanced antihypertensive group (systolic pressure control target <120 mmHg) and standard antihypertensive group (systolic pressure control target <140 mmHg). Pulse syndrome, stroke, heart failure, or cardiovascular death.

Sprint research results 1: From the perspective of blood pressure control: the blood pressure between the strengthening of the antihypertensive group and the standard antihypertensive group quickly appeared, and it was continuous. The rate is reduced by 27%. Sprint research confirmed that patients with high -risk cardiovascular events and high blood pressure without diabetes have the systolic blood pressure control of less than 120 mmHg than 140 mmHg below 140 mmHg, which can bring more significant clinical benefits. Grow up. It is found that the systolic blood pressure is better than the <130mmHg clinical benefit and adverse events, so the new hypertension diagnosis standard is defined. Blood pressure is divided into normal, high blood pressure, level 1 or level 2 hypertension according to blood pressure. Normal blood pressure is defined as <120/<80 mm hg, high blood pressure is 120-129/<80 mm HG, level 1 hypertension is 130-139/80-89 mm Hg, and level 2 hypertension is ≥140 or ≥ 90 mm HG. The blood pressure must be measured at different times to diagnose hypertension. It is also recommended to use outdoor and home self -testing blood pressure diagnosis of hypertension, as a basis for starting antihypertensive treatment. Although the new version of the US guide has redefined hypertension, not all patients with hypertension need drug treatment: patients with clinical cardiovascular disease If the average systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg needs to be used as a reduction of antihypertensive drugs. For secondary prevention of cardiovascular disease, patients with 10 -year risk without cardiovascular disease but atherosclerosis cardiovascular disease, if the average systolic blood pressure ≥130mmHg or diastolic pressure ≥80 mmHg, need to use antihypertensive drugs. As a first -level prevention of cardiovascular disease. In patients with 10 -year risk of cardiovascular disease, but atherosclerotic cardiovascular disease, if the average systolic blood pressure is ≥140 mm HG or diastolic blood pressure ≥90 mm HG, it is recommended to use antihypertensive drugs as a first -class prevention. If blood pressure can decrease significantly within a certain range, high -risk patients with atherosclerotic heart disease rarely need other treatments to prevent cardiovascular events, especially the elderly have coronary heart disease, diabetes, blood lipids, smoking and chronic kidney disease Patients, this is the last word of pressure. The incidence of hypertension before the age of 50 is lower than men, but the incidence of hypertension after 50 years of age increases.

At present, there is no random control study to evaluate the effective evidence to improve the primary afterwards. Except for the management of pregnancy hypertension, there are still no evidence to determine the blood pressure threshold of the drug treatment, the target value of the blood pressure, what drugs choose as the initial antihypertension as the initial antihypertensive voltage pressure The difference between a plan or combined with antihypertensive drugs between men and women. The risk of a clear cardiovascular disease or no cardiovascular disease but 10 years of atherosclerotic cardiovascular disease is ≥10%, and the target value of blood pressure is determined to <130/80 mmHg. For patients with hypertension, there are no other factors that increase the risk of cardiovascular disease. The target value of the blood pressure is defined as <130/80 mmh. The 2017 version of the hypertension guide is the update of JNC7. In addition to the target value of blood pressure treatment, it is a new information that contains cardiovascular disease, dynamic blood pressure monitoring, home self -test blood pressure related to blood pressure. Wait for various high blood pressure fields. <!-2664: Cardiovascular terminal page

Immediately after the update of the US Guide, on June 9, 2018, the 28th European Hypertension Annual Conference, 2018 ESC/ESH Hypertension Management Guide was officially promulgated. Due to the tremendous changes caused by the tremendous changes in the diagnostic standards of hypertension at the end of last year’s ACC/AHA hypertension guidelines, the academic community gave more attention to the release of the new European Guide from the beginning. Unlike the 2017 ACC/AHA Hypertension Guide defines hypertension as ≥130/80 mm HG. The new ESC guide’s definition of hypertension and the grading of blood pressure still follow the 13 -year version standard. 90 mm HG, and the grading of blood pressure has not changed. Although the new version of the guidelines did not change the diagnostic standard for hypertension, it recommended a more active treatment intervention plan, which also reflects the lower and lower trend of the antihypertensive target. Throughout the changes in the high blood pressure guide in recent years, it can be found that people’s awareness of high blood pressure is constantly improving and changing. High -risk patients start to reduce blood pressure at 130-139mmHg. Ordinary people must also take measures to reduce blood pressure. Patients with hypertension must prevent continued increase in blood pressure. If the blood pressure of low -risk patients is 130/80 mmHg, it may not be treated with drugs and only perform lifestyle intervention. However, if patients with diabetes and coronary heart disease are merged, intervention measures must be taken if the systolic blood pressure reaches 135 mmHg. The European Guide does not advocate that the lower blood pressure decreases, but the lower the blood pressure within a certain range, which can bring more benefits. Compared with previous guidelines, the new version of Guide recommends a more positive antihypertensive solution, which is mainly manifested in the following aspects. 1. Take more positive antihypertensive treatment among elderly patients, such as high -risk patients 65 to 80 years old (combined with cardiovascular complications or merging more than 2 to 3 risk factors): 1. The treatment of first -level hypertension drugs is category of IIB class. Recommended promotion to class I recommendation. 2. The target value of the antihypertensive target is more positive. For example, the new version of the guideline recommended the secondary prevention of antihypertensive targets is 120 to 130? MMHG. In addition, patients with hypertension with diabetes and coronary heart disease still recommend the antihypertensive target ≤130/80 mm HG. For the target value of 130 to 140 mm HG with hypertension patients with chronic kidney disease, the target value of 120 to 130 mm HG with high blood pressure patients with heart failure is recommended. In addition to the antihypertensive target value, the new version of the guidelines also made a clear explanation of the lower limit of hypertension control. This was not put forward by the previous version of the guidelines. For example Patients with chronic kidney diseases and elderly patients over 65 years old are less than 130/70 mm HG. The new version of European Guide is a more detailed and comprehensive guide.

With the update of the US Guide and the European Hypertension Guide, the China Hypertension Prevention Guide at the end of 2018 has also released a new version. Because hypertension is a cardiovascular syndrome, it is often combined with other cardiovascular risk factors, target organs damage and target organs Clinical diseases, so according to the blood pressure level and overall risk level of patients with hypertension, decide to give the timing and strength of improvement of lifestyle and antihypertensive drugs, and at the same time need to interfere with other risk factors, target organs damage and coexisting that have been detected. Clinical disease. Because the phenomenon of hypertension patients in high blood pressure still has no fundamental change in the phenomenon of stroke complications. In fact, there are some clinical research evidence in this regard. my country’s fever research results also support SBP below 130mmHg or lower can still reduce stroke occurrence. Essence Therefore, under the condition of conditions permit, the treatment strategy of strengthening blood pressure should be adopted. Generally, the blood pressure target of patients must be controlled below 140 /90mmHg. Under the tolerance and sustainable conditions, the blood pressure of high -risk patients such as diabetes and proteinuria can be controlled below 130 /80mmHg. Although there are also some evidence that higher or lower blood pressure targets among some special groups, this mainly depends on the patient’s tolerance and complexity of treatment. If you do not need to adopt a complex treatment plan, you can reduce the blood pressure to a lower level and the patient can tolerate it. The selection and application of the treatment scheme should weigh the long -term benefits and patient tolerance, and avoid or reduce the suspension of drugs caused by poor tolerance. Adopting active intervention measures for patients with high -risk and high -risk patients, as well as patients with active intervention measures to reverse the damage of target organs for patients with damage to sub -clinical target organs without severe complications, but give people with low and medium -sized blood pressure normal high -value groups. The treatment of antihypertensive drugs currently lacks clinical trial evidence based on the prognosis end. Although some studies have shown that elderly patients with hypertension patients have higher blood pressure targets than general hypertension patients, some recent research sub -group analysis also shows that lower blood pressure targets (SBP <130mmHg) are beneficial to the elderly. It is not a sufficient condition for setting the higher voltage reduction target. For elderly patients, doctors should evaluate the possible factors of treatment to tolerance and persistence treatment according to the severity of the patient's complications, and comprehensively determine the patient's antihypertensive target. Although epidemiological survey in the crowd survey the blood pressure above 115/75mmHg, the occurrence of blood pressure and cardiovascular and cerebrovascular incidents is a linear relationship, but currently lowering pressure in patients with low -risk and hypertension patients in general and low -risk high blood pressure The evidence -based evidence that reduces benefits is not very sufficient. The US guide defines the blood pressure diagnosis standard to 130/80 mm HG, and it still needs to be further confirmed by more and wider people's research. my country ’s hypertension guide does not have more than the definition of the US guide, in addition to insufficient evidence, it also considers the national conditions with low blood pressure control rate in my country, but 130/80mmHg also makes sense, because hypertension is more more than the more hypertension. Early management should have a certain positive significance for the prevention of cardiovascular disease in the overall population, especially the young people with high blood pressure. If they intervene in 30 years, it should be beneficial to reduce incidents. Perhaps in the past ten years, with the cumulative evidence increased, the diagnostic criteria for lower hypertension will be widely recognized.

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