ESH指南要点摘读.pptVIP

以诊室外血压为基础的治疗策略，能否在减少临床发病率和死亡率，减少药物和副作用方面优于传统的以诊室血压为基础的治疗策略？ * * * Data taken from European cardiovascular disease statistics 2008 仅供内部学习使用 治疗策略和降压药物选择的建议 推荐级别 证据等级 利尿剂 (噻嗪类，氯噻酮和吲哒帕胺)，β阻滞剂，CCB，ARB，无论是单独使用还是某种情况下与其他药物联合使用，都适合于高血压的初始和维持治疗 I A 在特定的条件下应该考虑优先选择某些药物，因为这些药物在研究的特定条件下被使用，或者是能显著改善某种类型的靶器官损害 IIa C 对于血压显著升高的患者或者是心血管危险高危以上的患者，应该考虑起始应用两种药物联合治疗 IIb C 不推荐两种RAS阻断剂的联合使用 III A 其他药物的联合也应该考虑，因为有可能对于降低血压有益。但是，应该优先推荐在临床研究中被成功使用的药物联合 IIa C 推荐优先使用两种药物固定剂量的单片复方制剂，因为减少每日服药数量可改善依从性，尤其是而目前高血压患者的依从性是较低的 IIb B 治疗策略和降压药物的选择 Journal of Hypertension 2013, 31:1281–1357 难治性高血压器械治疗尚须审慎 短期临床研究显示，使用颈动脉窦刺激器和去肾交感神经术（RDN）治疗可以有效降低血压。 对RDN的评价仅是“有希望（promising）” ，基于这是一项有创的干预方法，因此审慎、规范和在有效监督下进行长期的临床随访研究是目前比较切实可行的做法。 尚缺的证据和未来需要做的试验 Gaps in evidence and need for future trials Should antihypertensive drug treatment be given to all patients with grade 1 hypertension when their CV risk is low-to-moderate? (2) Should elderly patients with a SBP between 140 and 160 mmHg be given antihypertensive drug treatments? (3) Should drug treatment be given to subjects with white-coat hypertension? Can this condition be differentiated into patients needing or not needing treatment? 仅供内部学习使用 (4) Should antihypertensive drug treatment be started in the high normal BP range and, if so, in which patients? (5) What are the optimal of?ce BP values (i.e. the most protective and safe) for patients to achieve by treatment in different demographic and clinical conditions? (6) Do treatment strategies based on control of out-of-of?ce BP provide an advantage (reduced clinical morbidity and mortality,fewer drugs, fewer side-effects) over strategies based on conventional (of?ce) BP control? 仅供内部学习使用 (7) What are the optimal out-of-of?ce (home and ambulatory) BP values to be reached with treatment and should targets be lower or higher in high risk hypertensives? (8) Does central BP add to CV event prediction in untreated and treated hypertensive patients? (9) Do invasive procedures for treatment of resistant hypertension