诊治指南

Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children

The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)
Authors/Task Force Members: Bryan Williams* (ESC Chairperson) (UK),Giuseppe Mancia* (ESH Chairperson) (Italy), Wilko Spiering (The Netherlands),Enrico Agabiti Rosei (Italy), Michel Azizi (France), Michel Burnier (Switzerland),Denis L. Clement (Belgium), Antonio Coca (Spain), Giovanni de Simone (Italy),Anna Dominiczak (UK), Thomas Kahan (Sweden), Felix Mahfoud (Germany),Josep Redon (Spain), Luis Ruilope (Spain), Alberto Zanchetti† (Italy), Mary Kerins(Ireland), Sverre E. Kjeldsen (Norway), Reinhold Kreutz (Germany),Stephane Laurent (France), Gregory Y. H. Lip (UK), Richard McManus (UK),Krzysztof Narkiewicz (Poland), Frank Ruschitzka (Switzerland),Roland E. Schmieder (Germany), Evgeny Shlyakhto (Russia), Costas Tsioufis (Greece), Victor Aboyans (France), and Ileana Desormais (France)

The standardized techniques of blood pressure (BP) measurement in the clinic are emphasized and it is
recommended to replace the mercury sphygmomanometer by a non-mercury sphygmomanometer. Out-of-office
BP measurement using home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM) and even automated
office BP (AOBP) are recommended to correctly measure the patient’s genuine BP. Hypertension (HTN) treatment
should be individualized based on cardiovascular (CV) risk and the level of BP. Based on the recent clinical study
data proving benefits of intensive BP lowering in the high risk patients, the revised guideline recommends the
more intensive BP lowering in high risk patients including the elderly population. Lifestyle modifications, mostly low
salt diet and weight reduction, are strongly recommended in the population with elevated BP and prehypertension
and all hypertensive patients. In patients with BP higher than 160/100 mmHg or more than 20/10 mmHg above the
target BP, two drugs can be prescribed in combination to maximize the antihypertensive effect and to achieve
rapid BP control. Especially, single pill combination drugs have multiple benefits, including maximizing reduction of
BP, minimizing adverse effects, increasing adherence, and preventing cardiovascular disease (CVD) and target organ
damage.

The Korean Society of Hypertension guideline defines hypertension as systolic blood pressure ≥ 140 mmHg or
diastolic blood pressure ≥ 90 mmHg, where the effectiveness of pharmacological treatment has been established. It
is confirmed that higher blood pressure levels are associated with increased risk of cardiovascular disease and
mortality also in the Korean population. About one third of Korean adults aged 30 years or older are estimated to
have hypertension, and the prevalence of hypertension gradually increases as the age increases. The awareness,
treatment, and control rates of hypertension are generally improving in Korea, but more efforts are required to
increase awareness and treatment among younger patients with hypertension and to improve lifestyle modification
compliance at all ages. More studies are required to determine the magnitude and impact of white coat
hypertension and masked hypertension in the Korean population.

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
A Report of the American College of Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines

Treatment of hypertension improves cardiovascular, renal, and cerebrovascular outcomes. However, the benefit oftreatment may be different according to the patients’ characteristics. Additionally, the target blood pressure or initial drug choice should be customized according to the special conditions of the hypertensive patients. In this part III, we reviewed previous data and presented recommendations for some special populations such as diabetes mellitus, chronic kidney disease, elderly people, and cardio-cerebrovascular disease.

左心 室 肥 厚(left ventricular hypertrophy，LVH)是一种心室壁增厚、心肌重量增加和心肌重塑的心肌变化现象。在生理状态下一些从事高运动负荷的运动员可以出现代偿性LVH，但高血压作为引起心肌病理性改变的重要疾病之一，可导致血流动力学、神经体液等方面的诸多异常变化，使心肌产生病理性LVH。临床上有超过30%的高血压可能发生LVH，且发生率与高血压严重程度呈正相关。

本文刊于：中华心血管病杂志,2020,48 (03): 195-204 作者：中华医学会心血管病学分会女性心脏健康学组, 中华医学会心血管病学分会高血压学组 通信作者：陈韵岱，Email：cyundai@vip.163.com 李玉明，Em…

【指南与共识】SPECT心肌灌注显像技术与图像处理要点专家共识(2019版)

近年来，随着我国人口老龄化加快，急性心血管疾病发病率增加，因急性胸痛就诊的患者人数也逐年递增。急性胸痛临床表现不一、病情变化迅速、危险性差异悬殊、预后与疼痛程度不完全相关、救治时间依赖性强。随着胸痛中心建设的推广，我国胸痛诊疗日趋规范，但我国幅员辽阔、急诊诊疗能力存在差异，误诊、漏诊仍时有发生。因此，作为急性胸痛救治的第一站，院前急救和急诊科需快速评估、准确鉴别并科学处理，进而高效救治、合理分流胸痛患者。目前，院前急救与急诊科仍缺少急性胸痛急诊诊疗的指导性专家共识。为此，按照急性胸痛救治流程“早期诊断，危险分层，正确分流，科学救治”的指导方针，中华医学会急诊医学分会联合中国医疗保健国际交流促进会胸痛分会，组织院前急救、急诊医学、心血管病学等相关学科的专家共同撰写本共识。本共识强调“战线前移”，着眼整合区域救治网络，突出社区医疗、院前急救到急诊科、专科治疗的体系建设，并延伸至患者二级预防的全程管理；以急性胸痛早期流程优化和快速准确鉴别为重点，体现急诊特色的动态评估观念，加强多学科协作共赢，凸显急性胸痛救治应依托传统急诊急救基础建立起大平台、大数据体系进行全程管理、多环节和交叉学科协调融合的重要性。