Hemmelgarn B R, McAlister Finlay A, Grover Steven, Myers Martin G, McKay Donald W, Bolli Peter, Abbott Carl, Schiffrin Ernesto L, Honos George, Burgess Ellen, Mann Karen, Wilson Thomas, Penner Brian, Tremblay Guy, Milot Alain, Chockalingam Arun, Touyz Rhian M, Tobe Sheldon W
Division of Nephrology, University of Calgary, and Foothills Hospital, 1403 29th Street Northwest, Calgary, Alberta, Canada.
Can J Cardiol. 2006 May 15;22(7):573-81. doi: 10.1016/s0828-282x(06)70279-3.
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with high blood pressure.
For persons in whom a high blood pressure value is recorded, a diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the level of the blood pressure elevation, the approach used to monitor blood pressure (office, ambulatory or home/self), 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 the overall risk of adverse cardiovascular outcomes requires an assessment for other vascular risk factors and hypertensive target organ damage.
MEDLINE searches were conducted from November 2004 to October 2005 to update the 2005 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, the authors only included studies that had been published in the peer-reviewed literature and did not include evidence from abstracts, conference presentations or unpublished personal communications.
The present document contains recommendations for blood pressure measurement, diagnosis of hypertension, and assessment of cardiovascular risk for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for the 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 blood pressure monitoring, and the role of echocardiography for those with hypertension. Key features of the 2006 recommendations include continued emphasis on an expedited diagnosis of hypertension, an in-depth review of the role of global risk assessment in hypertension therapy, and the use of home/self blood pressure monitoring for patients with masked hypertension (subjects with hypertension who have a blood pressure that is normal in clinic but elevated on home/self measurement).
All recommendations were graded according to the strength of the evidence and were voted on by the 45 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported herein 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循证建议。
对于记录到高血压值的人群，高血压的诊断取决于血压的恰当测量、血压升高的水平、监测血压的方法（诊室、动态或家庭/自我测量）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患者，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2004年11月至2005年10月进行了MEDLINE检索，以更新2005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，作者仅纳入发表在同行评审文献中的研究，不包括摘要、会议报告或未发表的个人交流中的证据。
本文件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、高血压诊断标准及随访建议、总体心血管风险评估、常规和可选的实验室检查、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。2006年建议的关键特点包括继续强调高血压的快速诊断、对全球风险评估在高血压治疗中作用的深入审查，以及对隐匿性高血压患者（诊室血压正常但家庭/自我测量血压升高的高血压患者）使用家庭/自我血压监测。
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45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。
