Royal Adelaide Hospital, Adelaide, SA
Flinders Medical Centre, Flinders University, Adelaide, SA.
Med J Aust. 2016 Jul 18;205(2):85-9. doi: 10.5694/mja16.00526.
The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010). Main recommendations For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy. The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end-organ damage, together with accurate BP assessment. For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy. Treat patients with uncomplicated hypertension to a target BP of < 140/90 mmHg or lower if tolerated. Changes in management as a result of the guideline Ambulatory and/or home BP monitoring should be offered if clinic BP is ≥ 140/90 mmHg, as out-of-clinic BP is a stronger predictor of outcome. In selected high cardiovascular risk populations, aiming for a target of < 120 mmHg systolic can improve cardiovascular outcomes. If targeting < 120 mmHg, close follow-up is recommended to identify treatment-related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury. Why the changes have been made A 2015 meta-analysis of patients with uncomplicated mild hypertension (systolic BP range, 140-169 mmHg) demonstrated that BP-lowering therapy is beneficial (reduced stroke, cardiovascular death and all-cause mortality). A 2015 trial comparing lower with higher blood pressure targets in selected high cardiovascular risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment-related adverse events.
澳大利亚国家心脏基金会更新了 2008 年高血压管理指南：评估和管理成年人高血压（2010 年 12 月更新）。主要建议对于绝对心血管疾病风险低且持续性血压（BP）≥160/100mmHg 的患者，开始进行降压治疗。在较低的 BP 水平进行治疗的决定应考虑绝对心血管疾病风险和/或终末器官损害的证据，同时结合准确的 BP 评估。对于绝对心血管疾病风险中度且持续性收缩压≥140mmHg 和/或舒张压≥90mmHg 的患者，开始进行降压治疗。将患有单纯性高血压的患者治疗至目标 BP<140/90mmHg 或更低（如果耐受）。如果诊所 BP≥140/90mmHg，应提供动态和/或家庭 BP 监测，以改变管理方式，因为诊所外 BP 是预后的更强预测因素。在选择的高心血管风险人群中，目标收缩压<120mmHg 可以改善心血管结局。如果目标是<120mmHg，则建议密切随访，以识别与治疗相关的不良反应，包括低血压、晕厥、电解质异常和急性肾损伤。做出这些改变的原因2015 年一项对单纯轻度高血压（收缩压范围 140-169mmHg）患者的荟萃分析表明，降压治疗有益（降低中风、心血管死亡和全因死亡率）。2015 年一项在选择的高心血管风险人群中比较较低与较高血压目标的试验发现，心血管结局改善，死亡率降低，但某些与治疗相关的不良反应增加。
