Hemmelgarn Brenda R, McAllister Finlay A, Myers Martin G, McKay Donald W, Bolli Peter, Abbott Carl, Schiffrin Ernesto L, Grover Steven, Honos George, Lebel Marcel, Mann Karen, Wilson Thomas, Penner Brian, Tremblay Guy, Tobe Sheldon W, Feldman Ross D
Division of Nephrology, University of Calgary, Calgary, Canada.
Can J Cardiol. 2005 Jun;21(8):645-56.
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with high blood pressure (BP).
For persons in whom a high BP value is recorded, the assignment of a diagnosis of hypertension is dependent on the appropriate measurement of BP, the level of the BP elevation and the duration of follow-up. In addition, the presence of cardiovascular risk factors and target organ damage should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, estimating overall risk of adverse cardiovascular outcomes requires an assessment of other vascular risk factors and hypertensive target organ damage.
MEDLINE searches were conducted from November 2003 to October 2004 to update the 2004 recommendations. Reference lists were scanned, experts were polled, and the personal files of the authors and subgroup members were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content and methodological experts. As per previous years, only studies that had been published in the peer-reviewed literature were included; evidence from abstracts, conference presentations and unpublished personal communications was not included.
This document contains recommendations for BP measurement, diagnosis of hypertension and assessment of cardiovascular risk for adults with high BP. These include the accurate measurement of BP, criteria for diagnosis of hypertension, and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory BP monitoring, and the role of echocardiography for those with hypertension. Key features of the 2005 recommendations include an expedited diagnostic algorithm for hypertension and an endorsement of the use of home/self and ambulatory BP assessment as validated techniques in establishing the diagnosis of hypertension.
All recommendations were graded according to the strength of the evidence and voted on by the 43 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported in the present paper received at least 95% consensus. These guidelines will continue to be updated annually.
为成人高血压的诊断和评估提供最新的、基于证据的建议。
对于记录到血压值较高的人群，高血压诊断的确定取决于血压的恰当测量、血压升高水平以及随访时间。此外，应评估心血管危险因素和靶器官损害的存在情况，以确定治疗的紧迫性、强度和类型。对于被诊断为高血压的人群，估计不良心血管结局的总体风险需要评估其他血管危险因素和高血压靶器官损害。
于2003年11月至2004年10月进行了MEDLINE检索，以更新2004年的建议。对参考文献列表进行了筛选，向专家进行了咨询，并利用作者和亚组成员的个人文件来识别其他研究。由内容和方法学专家根据预先设定的证据水平对识别出的文章进行审查和评估。与前几年一样，仅纳入在同行评审文献中发表的研究；不包括摘要、会议报告和未发表的个人交流中的证据。
本文档包含关于成人高血压患者血压测量、高血压诊断以及心血管风险评估的建议。这些建议包括血压的准确测量、高血压诊断标准、随访建议、总体心血管风险评估、常规和可选实验室检查、肾血管和内分泌病因评估、家庭和动态血压监测，以及超声心动图在高血压患者中的作用。2005年建议的关键特征包括高血压的快速诊断算法，以及认可将家庭/自我和动态血压评估作为确诊高血压的有效技术。
所有建议均根据证据强度进行分级，并由加拿大高血压教育计划循证建议工作组的43名成员投票表决。本文报告的所有建议均获得至少95%的共识。这些指南将继续每年更新。
