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2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension.

作者信息

Wang Tzung-Dau, Chiang Chern-En, Chao Ting-Hsing, Cheng Hao-Min, Wu Yen-Wen, Wu Yih-Jer, Lin Yen-Hung, Chen Michael Yu-Chih, Ueng Kwo-Chang, Chang Wei-Ting, Lee Ying-Hsiang, Wang Yu-Chen, Chu Pao-Hsien, Chao Tzu-Fan, Kao Hsien-Li, Hou Charles Jia-Yin, Lin Tsung-Hsien

机构信息

Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital.

Department of Internal Medicine, School of Medicine, National Taiwan University College of Medicine.

出版信息

Acta Cardiol Sin. 2022 May;38(3):225-325. doi: 10.6515/ACS.202205_38(3).20220321A.


DOI:10.6515/ACS.202205_38(3).20220321A
PMID:35673334
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9121756/
Abstract

Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Despite the positive correlations between blood pressure (BP) levels and later CV events since BP levels as low as 100/60 mmHg have been reported in numerous epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years. The publication of both the SPRINT and STEP trials (comprising > 8,500 Caucasian/African and Chinese participants, respectively) provided evidence to shake this 140/90 mmHg dogma. Another dogma regarding hypertension management is the dependence on office (or clinic) BP measurements. Although standardized office BP measurements have been widely recommended and adopted in large-scale CV outcome trials, the practice of office BP measurements has never been ideal in real-world practice. Home BP monitoring (HBPM) is easy to perform, more likely to be free of environmental and/or emotional stress, feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events, compared to routine office BP measurements. In the 2022 Taiwan Hypertension Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS), we break these two dogmas by recommending the definition of hypertension as ≥ 130/80 mmHg and a universal BP target of < 130/80 mmHg, based on standardized HBPM obtained according to the 722 protocol. The 722 protocol refers to duplicate BP readings taken per occasion ("2"), twice daily ("2"), over seven consecutive days ("7"). To facilitate implementation of the guidelines, a series of flowcharts encompassing assessment, adjustment, and HBPM-guided hypertension management are provided. Other key messages include that: 1) lifestyle modification, summarized as the mnemonic S-ABCDE, should be applied to people with elevated BP and hypertensive patients to reduce life-time BP burden; 2) all 5 major antihypertensive drugs (angiotensin-converting enzyme inhibitors [A], angiotensin receptor blockers [A], β-blockers [B], calcium-channel blockers [C], and thiazide diuretics [D]) are recommended as first-line antihypertensive drugs; 3) initial combination therapy, preferably in a single-pill combination, is recommended for patients with BP ≥ 20/10 mmHg above targets; 4) a target hierarchy (HBPM-HMOD- ambulatory BP monitoring [ABPM]) should be considered to optimize hypertension management, which indicates reaching the HBPM target first and then keeping HMOD stable or regressed, otherwise ABPM can be arranged to guide treatment adjustment; and 5) renal denervation can be considered as an alternative BP-lowering strategy after careful clinical and imaging evaluation.

摘要

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本文引用的文献

[1]
Treatment for Mild Chronic Hypertension during Pregnancy. Reply.

N Engl J Med. 2022-8-18

[2]
Preprocedural features of patients under antihypertensive drugs may help identify responders to renal denervation: a hypothesis-generating study.

Rev Cardiovasc Med. 2022-2-16

[3]
Increased mortality with intensive control in patients with higher baseline SBP and lower Framingham risk.

J Hypertens. 2022-5-1

[4]
Antithrombotic Treatment of Stable Coronary Artery Disease.

Acta Cardiol Sin. 2021-11

[5]
Long-Term Prognostic Value of Mean Platelet Volume in Patients with Hypertension.

Acta Cardiol Sin. 2021-9

[6]
An Overview of Cardio-Oncology, a New Frontier to Be Explored.

Acta Cardiol Sin. 2021-9

[7]
Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension.

N Engl J Med. 2021-9-30

[8]
Effect of Salt Substitution on Cardiovascular Events and Death.

N Engl J Med. 2021-9-16

[9]
Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.

Catheter Cardiovasc Interv. 2021-9

[10]
European Society of Hypertension position paper on renal denervation 2021.

J Hypertens. 2021-9-1

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