S Afr Med J. 1995 Dec;85(12 Pt 2):1321-5.
To outline rational and cost-effective comprehensive management of hypertension by health care professionals in a primary care setting.
Control of hypertension with a target blood pressure (BP) of systolic 140 - 159 mmHg, diastolic 90 - 94 mmHg, with minimal or no drug side-effects. Reduce BP in the elderly and those with severe hypertension gradually. Stricter BP control is required for patients with end-organ damage, coexisting risk factors, diabetes mellitus. Extensive data including many randomised controlled trials showed the benefit of controlling hypertension. This evidence is reported in Opie L. H. and Steyn K., Rationale for the hypertension guidelines for primary care in South Africa, S Afr Med J 1995; 85: 1325-1338.
To treat as many of the untreated hypertensive patients as possible, using rational and cost-effective care. Cost-effectiveness and access to therapy are major issues.
BENEFITS, HARMS AND COSTS: Reduction in stroke, cardiac failure, renal failure and coronary artery disease. The major precautions and contraindications to each antihypertensive drug recommended are listed. The financial costs of the drugs are considered.
Correct BP measurement procedure. identification of blood pressure levels for appropriate management. Evaluation of other cardiovascular risk factors and their influence on when to treat hypertension. Lifestyle modification and patient education for all patients. Drug therapy: first line--low-dose diuretics; second line--reserpine or beta-blockers or ACE inhibitors or calcium channel blockers; third line--hydralazine or prazosin or another second-line drug. Drug treatment and referral or specific cases (pregnancy, diabetes mellitus, severe hypertension).
Developed by the Hypertension Society of Southern Africa Executive Committee and co-opted persons during 1995, with added input from HSSA members at the National Congress. Endorsed by the Medical Association of South Africa.
概述基层医疗环境中医疗保健专业人员对高血压进行合理且具成本效益的综合管理。
将高血压控制在收缩压140 - 159 mmHg、舒张压90 - 94 mmHg的目标血压水平，且药物副作用最小或无副作用。逐步降低老年人及重度高血压患者的血压。对于有靶器官损害、并存危险因素、糖尿病的患者，需要更严格地控制血压。大量数据（包括许多随机对照试验）表明控制高血压有益。此证据载于奥皮L.H.和斯泰恩K.所著的《南非基层医疗高血压指南的理论依据》，《南非医学杂志》1995年；85：1325 - 1338。
采用合理且具成本效益的护理，尽可能治疗更多未治疗的高血压患者。成本效益和治疗可及性是主要问题。
益处、危害和成本：降低中风、心力衰竭、肾衰竭和冠状动脉疾病的发生率。列出了推荐的每种抗高血压药物的主要预防措施和禁忌证。考虑了药物的财务成本。
正确的血压测量程序。确定适合管理的血压水平。评估其他心血管危险因素及其对何时治疗高血压的影响。对所有患者进行生活方式改变和患者教育。药物治疗：一线——小剂量利尿剂；二线——利血平或β受体阻滞剂或血管紧张素转换酶抑制剂或钙通道阻滞剂；三线——肼屈嗪或哌唑嗪或另一种二线药物。针对特定病例（妊娠、糖尿病、重度高血压）进行药物治疗和转诊。
由南非高血压协会执行委员会及特邀人员于1995年制定，南非高血压协会成员在全国代表大会上提供了更多意见。得到南非医学协会认可。
