成人高血压的初始评估
- Author
- Brent M Egan, MD
Brent M Egan, MD
- Professor of Medicine
- University of South Carolina School of Medicine-Greenville
- Chief Science Officer, Care Coordination Institute
- Section Editors
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Deputy Editor
- John P Forman, MD, MSc
John P Forman, MD, MSc
- Senior Deputy Editor — UpToDate
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
- Translators
- 任艺虹, 主任医师，教授
任艺虹, 主任医师，教授
- 中国人民解放军总医院心血管内科
引言
大多数高血压患者表现为血压轻度升高(即一期高血压，140-159/90-99mmHg)且无临床心血管疾病，也无高血压相关性靶器官损害的征象。在这种情况下，只有满足以下条件才能诊断为高血压：多个场合正确测量都证实血压升高，或者更为可取的方法是诊室外测量证实了诊室内所测血压升高(诊断流程 1)[1,2]。高血压的确诊以及血压测定方法将在别处讨论。 (参见“成人高血压的概述”，关于‘诊断’一节和“成人高血压诊断和管理时的血压测量”)
高血压患者(包括高血压前期患者)的恰当治疗取决于一些因素，包括是否存在特定共存疾病、总体心血管风险以及高血压是否是由另一种可能可逆的疾病引起[3]。 (参见“原发性高血压的药物治疗选择”和“高血压治疗中目标血压应该是多少”和“哪些患者应评估肾血管性或其他原因的继发性高血压？”)
因此，确诊高血压后，应进行评估以确定以下信息：
●靶器官损害的程度。
●患者的总体心血管风险状况。 (参见“Overview of the risk equivalents and established risk factors for cardiovascular disease”)
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- Harris KC, Benoit G, Dionne J, et al. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, and Assessment of Risk of Pediatric Hypertension. Can J Cardiol 2016; 32:589.
- Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:2935.
- Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation 2008; 118:e714.
- Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560.
- Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:2889.
- Egan BM, Li J, Qanungo S, Wolfman TE. Blood pressure and cholesterol control in hypertensive hypercholesterolemic patients: national health and nutrition examination surveys 1988-2010. Circulation 2013; 128:29.
- O'Brien E, Beevers G, Lip GY. ABC of hypertension. Blood pressure measurement. Part III-automated sphygmomanometry: ambulatory blood pressure measurement. BMJ 2001; 322:1110.
- Dasgupta K, Quinn RR, Zarnke KB, et al. The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 2014; 30:485.
- Senior R, Monaghan M, Becher H, et al. Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography. Heart 2005; 91:427.
- Forman JP, Choi H, Curhan GC. Uric acid and insulin sensitivity and risk of incident hypertension. Arch Intern Med 2009; 169:155.
- Laragh J. Laragh's lessons in pathophysiology and clinical pearls for treating hypertension. Am J Hypertens 2001; 14:603.
- Egan BM, Basile JN, Rehman SU, et al. Plasma Renin test-guided drug treatment algorithm for correcting patients with treated but uncontrolled hypertension: a randomized controlled trial. Am J Hypertens 2009; 22:792.
- Egan BM, Laken MA, Sutherland SE, et al. Aldosterone Antagonists or Renin-Guided Therapy for Treatment-Resistant Hypertension: A Comparative Effectiveness Pilot Study in Primary Care. Am J Hypertens 2016; 29:976.
- Kivimäki M, Batty GD, Singh-Manoux A, et al. Validating the Framingham Hypertension Risk Score: results from the Whitehall II study. Hypertension 2009; 54:496.
- Vasan RS. A risk score for risk factors: rationale and roadmap for preventing hypertension. Hypertension 2009; 54:454.
- Pursnani A, Massaro JM, D'Agostino RB Sr, et al. Guideline-Based Statin Eligibility, Coronary Artery Calcification, and Cardiovascular Events. JAMA 2015; 314:134.
- Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27:2121.
- Bakris GL, Molitch M. Microalbuminuria as a risk predictor in diabetes: the continuing saga. Diabetes Care 2014; 37:867.
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