Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia.
J Clin Hypertens (Greenwich). 2022 Sep;24(9):1218-1225. doi: 10.1111/jch.14553.
Hypertension is highly prevalent worldwide and is the major risk factor for heart failure (HF). More than half of the patients with HF in Asia suffer from hypertension. According to the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guideline, there are four stages of HF, including at risk for HF (stage A), pre-HF (stage B), symptomatic HF (stage C), and advanced HF (stage D). Given the high prevalence of hypertension as well as HF and the stronger association between hypertension and cardiovascular diseases in Asians compared to the west, measures to prevent and alleviate the progression to clinical HF, especially controlling the blood pressure (BP), are of priority for Asian populations. After reviewing evidence-based studies, we propose a BP target of less than 130/80 mmHg for patients at stages A, B, and C. However, relatively higher BP may represent an opportunity to maximize guideline-directed medical therapy (GDMT), which could potentially result in a better prognosis for patients at stage D. Traditional antihypertensive drugs are the cornerstones for the management of hypertension at stages A and B. Notably, calcium channel blockers (CCBs) are inferior to other drug classes for the preventing of HF, whereas diuretics are superior to others. For patients at stage C, GDMT is essential which also helps the control of BP. In particular, sodium-glucose cotransporter-2 (SGLT2) inhibitors are newer therapies recommended for the treatment of HF and presumably even in hypertension to prevent HF. Regarding patients at stage D, GDMT is also recommended if tolerable and measures should be taken to improve hemodynamics.
高血压在全球范围内高发，是心力衰竭（HF）的主要危险因素。亚洲超过一半的 HF 患者患有高血压。根据 2022 年美国心脏协会/美国心脏病学会/美国心力衰竭学会 HF 指南，HF 有四个阶段，包括 HF 风险（A 阶段）、HF 前期（B 阶段）、有症状的 HF（C 阶段）和晚期 HF（D 阶段）。鉴于高血压以及 HF 在亚洲的高患病率，以及与西方相比高血压与心血管疾病之间的关联更强，预防和减缓向临床 HF 进展的措施，特别是控制血压（BP），对亚洲人群来说是优先事项。在审查了基于证据的研究后，我们建议 A、B 和 C 阶段的患者的 BP 目标值低于 130/80mmHg。然而，相对较高的 BP 可能代表着最大化指南导向的药物治疗（GDMT）的机会，这可能为 D 阶段的患者带来更好的预后。传统的降压药物是 A 和 B 阶段高血压管理的基石。值得注意的是，钙通道阻滞剂（CCB）在预防 HF 方面不如其他药物类别，而利尿剂则优于其他药物。对于 C 阶段的患者，GDMT 是必不可少的，这也有助于控制 BP。特别是钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂是推荐用于 HF 治疗的新型疗法，推测甚至在高血压中也可用于预防 HF。对于 D 阶段的患者，如果可以耐受，也建议进行 GDMT，并应采取措施改善血液动力学。
