从动态血压监测指南共识—看高血压的管理PPT参考课件.ppt

NOTES FOR PRESENTERS: Definitions In this guideline the following definitions are used: Stage 1 hypertension Clinic blood pressure is 140/90?mmHg or higher and subsequent ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85?mmHg or higher. Stage 2 hypertension Clinic blood pressure is 160/100?mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure is 150/95?mmHg or higher. Severe hypertension Clinic systolic blood pressure is 180?mmHg or higher or clinic diastolic blood pressure is 110?mmHg or higher. Additional information: ABPM – ambulatory blood pressure monitoring HBPM – home blood pressure monitoring * * NOTES FOR PRESENTERS: These recommendations are not key priorities but have been included as they direct the management of hypertension. Recommendations in full: Use clinic blood pressure measurements to monitor the response to antihypertensive treatment with lifestyle modifications or drugs. [new 2011] [1.5.4] Aim for a target clinic blood pressure below 140/90?mmHg in people aged under 80?years with treated hypertension. [new 2011] [1.5.5] Aim for a target clinic blood pressure below 150/90?mmHg in people aged 80?years and over, with treated hypertension. [new 2011] [1.5.6] NICE推荐，如诊室血压≥140/90 mmHg，予动态血压监测(ABPM)明确高血压诊断。图为高血压诊断流程图，其中经初始的诊室血压测量后，一般高血压患者必须进过24小时动态血压这一步确诊高血压。可见ABPM的重要性。 * * * * * * 诊室或家庭血压监测发现血压升高，怀疑“高血压”者，如果血压波动较大，有时正常，有时升高，或多次测量血压的平均值在1、2级高血压范围内，即140-179/90-109mmHg； 确诊高血压并已接受降压治疗的患者，如果两个及以上药物足量联合治疗，血压仍未达标，即多次测量血压的平均值仍?140/90 mm Hg； 确诊高血压并已接受降压治疗的患者，血压已达标，但发生心脑血管并发症，如脑卒中、心力衰竭、心肌梗死、肾功能不全等，或出现了新的靶器官损害，如蛋白尿、左心室肥厚、腔隙性脑梗死等，或靶器官损害进行性加重； 未服用降压药物，诊室血压140/90mmHg，但家庭血压?135/85mmHg；或诊室或家庭血压120-139/80-89 mm Hg，但出现了靶器官损害，如蛋白尿、左心室肥厚、腔隙性脑梗死等，而并无糖尿病、血脂异常等其它心血管危险因素 * * 应选择按照国际标准方案如欧洲高血压学会国际方案等进行过独立临床验证（validation）的动态血压计，即选择验证过的型号； 在临床应用过程中，还要定期进行校准（calibration），以确保每台血压计在每个时间段的准确性 高血压并发症为研究目标的前瞻性临床研究的证据大多来自使用“示波法上臂式袖带动态血压计” 因此，在得到相应的临床研究证据前，其他类型的动态血压