中华肾病研究电子杂志
中華腎病研究電子雜誌
중화신병연구전자잡지
2014年
1期
1-6
,共6页
循证医学%高血压%治疗
循證醫學%高血壓%治療
순증의학%고혈압%치료
Evidence-based medicine%Hypertension%Treatment
《美国医学会杂志》（JAMA）发表的《2014成人高血压管理指南》（JNC8），提出了九项推荐意见，解答了三个问题：何时开始降压？降压的目标值？用什么药降压？何时开始降压和降压的目标值是一致的：≥60岁的老年人，血压应控制在150/90 mmHg以内；＜60岁的患者或合并糖尿病或慢性肾脏病，血压应控制在140/90 mmHg以内；超过上述界限应开始降压。合并肾脏病的高血压患者，降压药首选血管紧张素转换酶抑制剂（ACEI）或者血管紧张素受体阻滞剂（ARB）（两者不宜联合使用），也可选用噻嗪类利尿剂和钙通道阻滞剂（CCB）；对于其他非黑人高血压患者，上述4种药物均为一线降压药物。当一个降压药不能将血压降至目标值时，可以加量也可以联合其他降压药。
《美國醫學會雜誌》（JAMA）髮錶的《2014成人高血壓管理指南》（JNC8），提齣瞭九項推薦意見，解答瞭三箇問題：何時開始降壓？降壓的目標值？用什麽藥降壓？何時開始降壓和降壓的目標值是一緻的：≥60歲的老年人，血壓應控製在150/90 mmHg以內；＜60歲的患者或閤併糖尿病或慢性腎髒病，血壓應控製在140/90 mmHg以內；超過上述界限應開始降壓。閤併腎髒病的高血壓患者，降壓藥首選血管緊張素轉換酶抑製劑（ACEI）或者血管緊張素受體阻滯劑（ARB）（兩者不宜聯閤使用），也可選用噻嗪類利尿劑和鈣通道阻滯劑（CCB）；對于其他非黑人高血壓患者，上述4種藥物均為一線降壓藥物。噹一箇降壓藥不能將血壓降至目標值時，可以加量也可以聯閤其他降壓藥。
《미국의학회잡지》（JAMA）발표적《2014성인고혈압관리지남》（JNC8），제출료구항추천의견，해답료삼개문제：하시개시강압？강압적목표치？용십요약강압？하시개시강압화강압적목표치시일치적：≥60세적노년인，혈압응공제재150/90 mmHg이내；＜60세적환자혹합병당뇨병혹만성신장병，혈압응공제재140/90 mmHg이내；초과상술계한응개시강압。합병신장병적고혈압환자，강압약수선혈관긴장소전환매억제제（ACEI）혹자혈관긴장소수체조체제（ARB）（량자불의연합사용），야가선용새진류이뇨제화개통도조체제（CCB）；대우기타비흑인고혈압환자，상술4충약물균위일선강압약물。당일개강압약불능장혈압강지목표치시，가이가량야가이연합기타강압약。
The “2014 Evidence-Based Guideline for the Management of High Blood Pressure (BP)in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC8)”published in the Journal of the American Medical Association (JAMA),has made nine recommendations,and answered three questions:when to initiate antihypertensive pharmacologic therapy?What′s the specified BP goal of treatment with the antihypertensive pharmacologic therapy?What drugs should be used for the treatment from the various antihypertensive drugs or drug classes?When to initiate antihypertensive therapy is consistent with the goal of antihypertensive therapy.In the general population aged ≥60 years,initiate pharmacologic treatment to lower BP at ≥150/90 mmHg to a goal BP <150/90 mmHg.In the population aged <60 years, with or without chronic kidney disease (CKD)/diabetes,initiate pharmacologic treatment to lower BP at ≥140/90 mmHg to a goal BP <140/90 mmHg.In hypertensive patients complicated with CKD,initial antihypertensive treatment should include an angiotensin-converting enzyme inhibitor (ACEI)or angiotensin receptor blocker (ARB)(the two should not be used in combination)to improve kidney outcomes,although a thiazide-type diuretic,or calcium channel blocker (CCB)can also be included.For other non-black patients with hypertension,each of the above four classes (thiazide-type diuretic,CCB,ACEI,or ARB)can be used as the first-line antihypertensive drugs.If goal BP is not reached within a month of treatment,increase the dose of the initial drug or add more drugs from the four classes mentioned above.
