Department of Medicine, Fortis-Escorts Hospital, Jaipur, India.
Indian J Med Res. 2010 Nov;132(5):531-42.
High blood pressure (BP) is a major public health problem in India and its prevalence is rapidly increasing among urban and rural populations. Reducing systolic and diastolic BP can decrease cardiovascular risk and this can be achieved by non-pharmacological (lifestyle measures) as well as pharmacological means. Lifestyle changes should be the initial approach to hypertension management and include dietary interventions (reducing salt, increasing potassium, alcohol avoidance, and multifactorial diet control), weight reduction, tobacco cessation, physical exercise, and stress management. A number of pharmaceutical agents, well evidenced by large randomized clinical trials, are available for initial treatment of high BP. These include older molecules such as thiazide diuretics and beta-blocking agents and newer molecules, dihydropyridine calcium channel blockers (CCB), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARB). In view of the recent clinical trials data, some international guidelines suggest that CCB, ACE inhibitors or ARB and not beta-blockers or diuretics should be the initial therapy in hypertension management. Comprehensive hypertension management focuses on reducing overall cardiovascular risk by lifestyle measures, BP lowering and lipid management and should be the preferred initial treatment approach.
高血压（BP）是印度的一个主要公共卫生问题，其在城市和农村人口中的患病率正在迅速上升。降低收缩压和舒张压可以降低心血管风险，这可以通过非药物（生活方式措施）和药物手段来实现。生活方式的改变应该是高血压管理的初始方法，包括饮食干预（减少盐、增加钾、避免饮酒和多因素饮食控制）、减肥、戒烟、体育锻炼和压力管理。许多经大型随机临床试验充分证实的药物制剂可用于高血压的初始治疗。这些药物包括噻嗪类利尿剂和β受体阻滞剂等较老的药物，以及二氢吡啶钙通道阻滞剂（CCB）、血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）等较新的药物。鉴于最近的临床试验数据，一些国际指南建议，在高血压管理中，CCB、ACE 抑制剂或 ARB 而不是β受体阻滞剂或利尿剂应作为初始治疗。全面的高血压管理侧重于通过生活方式措施、降低血压和血脂管理来降低整体心血管风险，应作为首选的初始治疗方法。
