PepsiCo, Inc, Purchase, NY 10755, USA.
Cardiol Clin. 2010 Nov;28(4):609-22. doi: 10.1016/j.ccl.2010.08.002.
Hypertension and prehypertension are major public health challenges. Prevention and control of prehypertension through lifestyle changes and the treatment of hypertension to goal blood pressure (BP) are important objectives. In most patients, 2 or more medications with complementary mechanisms of action should be used in combination. Referral for evaluation of resistant hypertension should be made when goal BP is not attained while patients are adherent on 3 or more appropriately dosed antihypertensive medications, including a diuretic. There are compelling indications for the use of specific drugs in patients with underlying ischemic heart disease, chronic heart failure, diabetes, chronic kidney disease, stroke, peripheral arterial disease, left ventricular hypertrophy, obesity, and metabolic syndrome. Adverse drug effects should be identified early and managed promptly to address patient safety and adherence. Other factors that affect adherence include the patient's health literacy level and ability to self-manage. The social, environmental, cultural, and financial sources of support in care must be addressed to achieve the full benefits of treatment and control of hypertension and prehypertension.
高血压和高血压前期是主要的公共卫生挑战。通过生活方式改变预防和控制高血压前期，并将高血压治疗到目标血压（BP）是重要目标。在大多数患者中，应使用 2 种或更多具有互补作用机制的药物联合治疗。当患者在服用 3 种或更多适当剂量的降压药物（包括利尿剂）且依从性良好的情况下仍未达到目标血压时，应转诊进行难治性高血压评估。对于存在潜在缺血性心脏病、慢性心力衰竭、糖尿病、慢性肾脏病、卒中等情况的患者，有明确的药物使用指征。对于左心室肥厚、肥胖和代谢综合征等情况的患者，也有明确的药物使用指征。应尽早识别药物不良反应并及时处理，以确保患者安全和依从性。影响依从性的其他因素包括患者的健康素养水平和自我管理能力。在提供护理时，必须解决社会、环境、文化和经济方面的支持来源问题，以充分实现高血压和高血压前期治疗和控制的益处。
