台湾心脏病学会（TSOC）及台湾高血压学会（THS）2017年高血压管理指南重点更新版
The 2017 Focused Update of the Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS) for the Management of Hypertension.
作者信息
Chiang Chern-En, Wang Tzung-Dau, Lin Tsung-Hsien, Yeh Hung-I, Liu Ping-Yen, Cheng Hao-Min, Chao Ting-Hsing, Chen Chen-Huan, Shyu Kou-Gi, Ueng Kwo-Chang, Chen Chung-Yin, Chu Pao-Hsien, Sung Shih-Hsien, Wang Kang-Ling, Li Yi-Heng, Wang Kuo-Yang, Chiang Fu-Tien, Lai Wen-Ter, Chen Jyh-Hong, Chen Wen-Jone, Yeh San-Jou, Chen Ming-Fong, Lin Shing-Jong, Lin Jiunn-Lee
机构信息
General Clinical Research Center, Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University.
Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei.
出版信息
Acta Cardiol Sin. 2017 May;33(3):213-225. doi: 10.6515/acs20170421a.
Hypertension (HT) is the most important risk factor for cardiovascular diseases. Over the past 25 years, the number of individuals with hypertension and the estimated associated deaths has increased substantially. There have been great debates in the past few years on the blood pressure (BP) targets. The 2013 European Society of Hypertension and European Society of Cardiology HT guidelines suggested a unified systolic BP target of 140 mmHg for both high-risk and low-risk patients. The 2014 Joint National Committee report further raised the systolic BP targets to 150 mmHg for those aged ≥ 60 years, including patients with stroke or coronary heart disease, and raised the systolic BP target to 140 mmHg for diabetes. Instead, the 2015 Hypertension Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society suggested more aggressive BP targets of < 130/80 mmHg for patients with diabetes, coronary heart disease, chronic kidney disease with proteinuria, and atrial fibrillation patients on antithrombotic therapy. Based on the main findings from the Systolic Blood Pressure Intervention Trial (SPRINT) and several recent meta-analyses, the HT committee members of the Taiwan Society of Cardiology and the Taiwan Hypertension Society convened and finalized the revised BP targets for management of HT. We suggested a new systolic BP target to < 120 mmHg for patients with coronary heart disease, chronic kidney disease with an eGFR of 20-60 ml/min/1.73 m, and elderly patients aged ≥ 75 years, using unattended automated office BP measurement. When traditional office BP measurement is applied, we suggested BP target of < 140/90 mmHg for elderly patients with an age ≥ 75 years. Other BP targets with traditional office BP measurement remain unchanged. With these more aggressive BP targets, it is foreseeable that the cardiovascular events will decrease substantially in Taiwan.
高血压（HT）是心血管疾病最重要的危险因素。在过去25年中，高血压患者数量及相关估计死亡人数大幅增加。过去几年关于血压（BP）目标存在诸多争论。2013年欧洲高血压学会和欧洲心脏病学会高血压指南建议，高危和低危患者统一的收缩压BP目标为140 mmHg。2014年美国国家联合委员会报告进一步将≥60岁人群（包括中风或冠心病患者）的收缩压BP目标提高到150 mmHg，将糖尿病患者的收缩压BP目标提高到140 mmHg。相反，2015年台湾心脏病学会和台湾高血压学会的高血压指南建议，对于糖尿病、冠心病、伴有蛋白尿的慢性肾病患者以及接受抗血栓治疗的房颤患者，采用更积极的BP目标，即<130/80 mmHg。基于收缩压干预试验（SPRINT）的主要研究结果及近期的几项荟萃分析，台湾心脏病学会和台湾高血压学会的高血压委员会成员召开会议并最终确定了高血压管理的修订BP目标。我们建议，对于冠心病、估算肾小球滤过率（eGFR）为20 - 60 ml/min/1.73 m²的慢性肾病患者以及≥75岁的老年患者，使用无人值守自动诊室血压测量时，新的收缩压BP目标为<120 mmHg。当采用传统诊室血压测量时，我们建议年龄≥75岁的老年患者BP目标为<140/90 mmHg。其他采用传统诊室血压测量的BP目标保持不变。有了这些更积极的BP目标，可以预见台湾的心血管事件将大幅减少。
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