This afternoon, the ISH Global Hypension Practice Guidelines was promulgated. This guide is formulated for different development degrees of development worldwide, and proposed “basic standards” and “best standards” in low -income regions and high -income regions.
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According to statistics in 2010, there are currently about 1.39 billion hypertensive patients worldwide, of which over 1 billion patients with hypertension in low -income countries (LHIC), while high -income countries (HIC) patients exceed 300 million.
At the global conference, ISH Chairman Thomas Unger raised such three questions:
Is this guide necessary?
Is it based on evidence -based formulation?
Does low -income countries have reference value?
The answer is of course: “Yes! Yes! Yes!” Let’s take a look at the guide.
Definition of hypertension and blood pressure measurement:
Both the clinic and outdoor are important!
For the blood pressure of the clinic, the global high blood pressure practice guide is divided into 4 categories:
Normal blood pressure: <130/85 mmHg;
Normal high value blood pressure: 130-139/85-89 mmHg;
Level 1 Hypertension: 140-159/90-99 mmHg;
Grade 2 Hypertension: ≥160/100 mmHg.
Thomas Unger pointed out that the diagnosis of patients with hypertension should refer to the blood pressure value of indoor and outdoor outdoor when conditions permit; not according to the increase in blood pressure as a basis for diagnosis of hypertension, it should be repeated within 1-4 weeks. For 2-3 times, people with continuous increase in blood pressure can diagnose hypertension; patients with blood pressure ≥180/110 mmHg and cardiovascular disease with cardiovascular disease can directly diagnose hypertension.
For patients with normal and high -value patients, blood pressure can be improved through lifestyle intervention; if there is no improvement in lifestyle intervention, drug treatment can be selected. For patients with high blood pressure (level 1 and level), patients should receive appropriate drug treatment.
For the blood pressure measurement of the clinic, the guidelines are recommended to measure the blood pressure of the arms at the same time. If the blood pressure difference between different arms is measured 3 times, the blood pressure difference between different arms> 10 mmHg should refer to the blood pressure measurement value with higher blood pressure value. If the difference is> 20 mmHg, further inspection should be considered. The guide also puts forward specific suggestions on the conditions and equipment of the blood pressure measurement of the clinic.
The new guide also puts forward suggestions on blood pressure management:
For patients with blood pressure <130/85 mmHg, the blood pressure assessment should be re -blood pressure within 3 years (if other risk factors can be reduced to 1 year);
For patients with blood pressure at 130-159/85-99 mmHg, if dynamic blood pressure monitoring or home blood pressure monitoring may be performed to eliminate the possibility of white coat hypertension or pseudo-hypertension, or by regular follow-up monitoring of blood pressure , Evaluate blood pressure;
If blood pressure> 160/100 mmHg, diagnosis can be diagnosed within a few days or weeks.
In terms of risk factors, the new guidelines divide the risk factors of cardiovascular diseases related to high blood pressure into three categories: low -risk, medium -risk, and high risk, which is a very high -risk classification than the Chinese guide.
Drug treatment: NASIDS, ginseng is named, SPC is boasted
Among the new guidelines announced this time, the drugs that will cause increased blood pressure are listed. Among them, the name is NASIDS (NASIDS). Waiting will also cause blood pressure to rise.
The new guide recommends patients with level 2 hypertension (blood pressure ≥160/100 mmHg) immediately initiated the treatment of antihypertensive drugs. The treatment of hypertension drugs, the guide pointed out that A (ACEI or ARB), C (dihydrial calcium antagonist) or D (thiazide -like diuretic) can be selected during the treatment of single drugs. Single -medicine treatment effects (SPC) when the effect of single medicine is not good is the ideal treatment plan. You can adjust the medication according to the following 4 steps (the highlight of the highlight):
Initial treatment can choose small doses of renin-vascular tension-aldehyde solid ketone system (RAAS) inhibitors such as vascular tensionase conversion enzyme inhibitors (ACEI) or vascular tension receptor inhibitors (ARB)+dihydrial calcium calcium ion ions Channel blocker (CCB);
For patients who fail to control blood pressure at level 1, you can choose a sufficient application A+C;
Patients who have not reached the standard can use tri -combined therapy (A+C+thiazide -like diuretic);
Patients who do not meet the standards, that is, patients with refractory hypertension can use snail or other drugs on the basis of Sanlian.
The guide also pointed out that if there is no SPC in the area, the amount and type of use can be adjusted according to the specific conditions of the patient; for patients with factors such as heart failure, angina pectoris, old myocardial infarction, and atrial fibrillation, β should be considered -D receptor blocker.
The ideal drug treatment has the following characteristics:
1. Treatment should be based on the prevention rate/mortality rate;
2. The frequency of medication is once a day, which can control blood pressure 24 hours;
3. Compared with other drugs, there should be ideal cost -effectiveness; 4. Treatment should have good safety and tolerance.
5. Evidence -based support for beneficiaries.
Look at the antihypertensive target:
Basic standards: blood pressure drops at least 20/10mmHg, it is best to drop to <140/90 mmHg;
Best standard: <65 -year -old patient: 65 -year -old patients: <140/90 mmHg, but the control target should be flexibly grasped according to the specific situation.
There is a treatment of complications, look at it here:
Cross -hearted heart disease (CAD): The blood pressure should be reduced to <130/80mmHg. Prefer to choose ACEI/ARB or β-receptor blockers ± CCB;
Merge stroke: blood pressure should be reduced to <130/80mmHg. Prefer to choose ACEI/ARB, CCB and diuretics;
Combined heart failure: lower blood pressure to <130/80mmHg. Prefer to choose ACEI/ARB, β-receptor blockers, CCB can be used if necessary;
Merge -chronic kidney disease (CKD): lower blood pressure to <130/80 mmHg. Choose ACEI/ARB first, add CCB or diuretic if necessary;
Consolidating chronic obstructive pulmonary disease (COPD): blood pressure should be reduced to <130/80 mmHg. Prefer to choose ACEI/ARB, CCB, diuretics;
Diabetes: The target value of blood pressure is <130/80 mmHg. Choose ACEI/ARB first, and use CCB or diuretic if necessary.
The key content is almost the same, let’s take a look at the suggestions of the expert ~
Professor Guo Yifang:
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Perhaps I had a high expectation of this guide in the early stage, and was a little disappointed after reading it. I think this new ISH guide is the integrated version of the European and American guidelines, and there are not many characteristics. Although this guidelines are trying to give different recommendations for high blood pressure prevention and control of high -blood pressure in developed regions and regions of medical resources, these suggestions are not specific and are not operable. If I let me introduce this guide in one sentence, then -do the regions of conditions to do in accordance with the European guide, and there are no conditions to lower the pressure as much as possible.
Indeed, there is no special highlight in the new guide, so we still unswervingly follow the “Chinese characteristics” step -down treatment route!