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黑人高血压的治疗

Author
Brent M Egan, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc
Translators
闫振成, 主任医师，教授

引言

高血压是黑人患者中的一个重大问题；黑人与其他人种/种族相比，高血压的心血管和肾脏并发症发病率和患病率更高。例如，45-64岁高血压黑人患者的脑卒中调整相对危险度是年龄相近的白人患者的2倍以上(表 1)[1]。因此，有效的抗高血压治疗在这些患者中尤其重要[2]。 (参见“黑人高血压并发症”)

根据国际黑人高血压协会的2010年推荐[3]，抗高血压治疗被推荐用于无靶器官损害或合并心血管疾病的血压高于135/85mmHg的黑人患者，以及风险更大的血压高于130/80mmHg的黑人患者。此外，不再强调单药治疗，而支持联合治疗。另一方面，包括各种专家小组在内的许多权威机构尚未推荐在黑人患者中启动比其他患者群中更低血压目标的抗高血压治疗(表 2)[4-6]。

黑人和白人在高血压控制方面的大部分差异是由于黑人男性比白人男性具有更低的高血压控制率(表 3)。除了需要更加广泛和有效的针对高血压黑人患者的治疗外，加强筛查和患者教育的新方法，比如基于理发店的干预性试验所阐述的方法[7]也可能增加黑人男性的高血压控制率，并改善高血压控制的人种均衡性。

抗高血压药的选择

黑人患者中药物或药物组合的最佳选择主要取决于是否存在共存疾病，以及药物对获得目标血压的具体效果[8]。总的来说，黑人患者中抗高血压药的选择与年龄较大成人中的相似。

概述 — 有关抗高血压治疗的选择的推荐将在别处讨论。简单来说：

         

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-30.
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