Royo-Bordonada M Á, Armario P, Lobos Bejarano J M, Pedro-Botet J, Villar Alvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Cammafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P
Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España.
Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA.
Hipertens Riesgo Vasc. 2017 Jan-Mar;34(1):24-40. doi: 10.1016/j.hipert.2016.11.006. Epub 2016 Dec 23.
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
《第六届欧洲心血管疾病预防指南》建议将人群策略和高危策略与生活方式改变相结合,作为预防的基石,并提出使用SCORE函数来量化心血管疾病风险。该指南强调针对特定疾病的干预措施,以及女性、年轻人和少数民族等特殊情况。不建议使用非侵入性成像技术筛查亚临床动脉粥样硬化。该指南根据风险将风险水平分为四级(极高、高、中、低),并针对血脂控制设定了治疗目标。糖尿病会带来高风险,但病程小于10年、无其他风险因素或并发症的2型糖尿病患者,或病程短且无并发症的1型糖尿病患者除外。启动动脉高血压药物治疗的决策将取决于血压水平和心血管疾病风险,并考虑靶器官损害情况。该指南不建议在一级预防中使用抗血小板药物,因为出血风险会增加。药物治疗依从性低需要简化治疗方案,并识别和解决其原因。该指南强调医疗专业人员有责任在倡导基于证据的人群层面干预措施方面发挥积极作用,并在个人和人群层面提出有效的干预措施,以促进健康饮食、体育锻炼、戒烟和预防酗酒。