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1 ChinJHypertensDecember2013Vol.21No 高血压联盟 ( 中国 ) 国家心血管病中心中华医学会心血管病学分会中国医师协会高血压专业委员会吴兆苏霍勇王文赵连友朱鼎良代表中国高血压患者教育指南编撰委员会 ( ) : (1) ( ) (4) (5) (2) 41% ( ) % 50% 40%~50% 15%~30% % 10% % 20 ( ) (3) : : ( ) wangwen5588@126.com 中国高血压患者教育指南编撰委员会

2 ChinJHypertensDecember2013Vol.21No () : ( ) ( ) ( ) 3~7d ( 1~3 ) 1min : 1 min : 1 h/d 0.5~ : 1.0kg 1( ) 2( 2:2 ) 3( ) 4( ) ( ) 1/ 1.3 <140/90 mm Hg (1) : (1mm Hg=0.133kPa) (2) :

3 ChinJHypertensDecember2013Vol.21No : (1) 10min (2) : ( (3) ) ( ) (4) ( ) ( (5) ) : (1) (2) <120/80mm Hg ( ) 30~ 40mm Hg ( ) ( ) (1) 24h 1~3 (2) (3) (6) 2.2 (4) 3 140mm Hg() [1] 90mm Hg %

4 ChinJHypertensDecember2013Vol.21No.12 3 (mm Hg) <120 <80 120~139 () 80~ () 90 1 ( ) 140~159 () 90~99 2 ( ) 160~179 () 100~109 3 ( ) 180 () <90 ( ) (bodymassin- dexbmi) ( ) 2.3 : / : : ( 55 ) (ankle-armbloodpressurein- 6 1 dexabi) (pulse wavevelocity PWV) % % % 2.66 [2] 24h ( ) 2.9 CT 350 (41%) : / 2. [1] 70%~80% 2.6 : ( ) : : CT :Doppler CT 20% ~30% :

5 ChinJHypertensDecember2013Vol.21No [14-17] : [18] / [3-4] 3.1 (2~3g) (>6g/d) [19] 3.6 ( ) [5-7] [8-9] 8~10g/d 12~15g/d WHO 5g g WHO 4.7g 4 9g 6g 22% ( ) 16% 3.2 / 2. 70% 50% : [10-11] [20] 2 : [12-13] 3.3 5%~10% 4.1 [1] 2 (1) : 3 : 3.4 : : :

6 ChinJHypertensDecember2013Vol.21No.12 20mm Hg 10mm Hg 1 [23] [24] (2): 250 [2] [25] 70% [26-27] ( ) : ( ) : 2~15mm : ( ) : [1] / 24h [28] 1/ [21] (3) : ~15 4 [22] (4) : (5): >55() >65() (6) 115/75 mm Hg (7) : ( ) (mm Hg) ( ( ( 140~ ~ ~99) 100~109) 110) 1~2 3 / 5 12m/s

7 ChinJHypertensDecember2013Vol.21No ( ) [29] 10 3 : : 7 ( BMI ) (6) : : 10 (%) <10% 10%~20% >20% 1: mm HgBMI27kg/m mmol/L 7 / (/58) 4 (160mm Hg) 5 BMI(27kg/m 2 ) 1 (6.24mmol/L) 1 () 2 6 () : () (mm Hg) 35~<40 0 < ~< ~< ~< ~< ~< ~< ~< ~< BMI(kg/m 2 ) (mmol/l) <24 0 < ~< : ( ) :BMI: % 5 [330-31] 5.1 : 10ICVD (%) 10ICVD (%) :BMI: ICVD: / [32]

8 ChinJHypertensDecember2013Vol.21No.12 [32-33] [33-34] g 3g [35] 2 3 <25g( [36] ( ) [3539] (1) : [37] :1 2g( 2g ) 6g( 6g) 2 (2) : 3 : C 4 5 4cm 400~500g(8 ~1 5g6 ) 1~ [38] <500mg/d 3 500~1200mg/d >1200mg/d (800mg/d) 250~ (4) 4 :1 2.5 ) 4 (3) : 390.6mg/d 500mL/d (1) : :1 (2) : 2 3 : 4 : 2% (3) : / :1 : 2 :

9 ChinJHypertensDecember2013Vol.21No : 0.5~1.0kg %~10% / [40] : ( )3 ( ) (1)BMI [41] : [45] / BMI : BMI= (kg)/ 2 (m 2 ) BMI :BMI18.5~<24.0kg/m ~<28.0kg/m kg/m 2 (kg)=22 2 (m 2 ) : (kg)= (cm)-105 (2) : 25% 30% ( ) (3) ( [42-43] : :(1) (2) ) ( ) (3) >90cm >0.90 >85cm (5) >0.85 : (6) 1( :cm) : ( :cm) (7) (4) : + : [1044] 1kg mm Hg / : [48] [46] 5.4 [2] 140 [47] (4) :

1132 201312 21 12ChinJHypertensDecember2013Vol.21No.12 1( ) : * 1 1 2 1/(4)1 1 5.1.3.2 [57] 10~15 [49] [50] (3): 2~3 25g : 10~30s 39 2~4 60s 32.

10 ChinJHypertensDecember2013Vol.21No.12 1( ) : * /(4) [57] 10~15 [49] [50] (3): 2~3 25g : 10~30s 39 2~4 60s 32.5% 13% ~15% 4% <100~150mL( 2~3 ) <250~ 500mL( ~1 )<25~50 ml( ~ 1) 180/110 mm Hg : (1) : 3~ 5 30 min : [55] :1 : 2 : 3 : =170- [56] 5 10min (2) : 2~3 48h (4) : (5) : [ ] [58-59] (6) : 30~50mm Hg [53] 10 min ~22h [54]

11 ChinJHypertensDecember2013Vol.21No : [1] %~50% 8 ( ) [61] h 50% [60] (1) : (2) : 24h 2~3/d (3) : 30% ~40% % 1. : [62] SPC 2. : 3. : <140/90mm Hg ( <150/90mm Hg 4. : 4~ % ~30% [1] (4) : ) (1) 5. (2) 24h (angiotensinconvertingenzymeinhibitors ACEI) (angiotensinrecep- (3) torblockersarb) β (4) (single-pilcombinationspc) (1) : 6. <140/90 mm Hg

12 ChinJHypertensDecember2013Vol.21No.12 [63-65] ( ) <150/90mm Hg ACEI [66-67] ( ) 60~70mm Hg [68] (2) : ACEI ACEI (3)ARB: [ (70% ) ] ACEI ACEI (3) : [74-76] : ARB 4~12 ACEI ARB (4) : 1~ [77] 2 ( ) : [1] ( ) ACEI ARB β SPC 12.50mg/d 25 mg [68-69] α (1) : (5) β : β [70] [78-80] : Ⅲ : 2/d : 2/d (Ⅰ Ⅱ) β 2~3/d : ACEI/ARB ( ) β β 1 β (2)ACEI: ( <60/min ) [71-73] ACEI 2~ ACEIARB β 3/d 1~2 /d ACEI 6.25~ ACEIARB 5.2.6

13 ChinJHypertensDecember2013Vol.21No [1] : ACEI ARB [81] ACEI [82] ARB β ( ) [83] [1] 3 : 2 : ACEIARB SPC SPC ( ) 1 SPC: ( 0 ( [84] ) ( ) )3 [85-86] 2 SPC: ( / / / )4 ( / / SPC ARB ACEI 3 SPC: [87-88] SPC / / [89] ~ /90 mm Hg 24h (1) : 10% 1% ~5% : β (3) ACEI/ARB [90-91] % ) ( ) )5 (2) ( ) ( / :1 ( >20/10mm Hg 30%

14 ChinJHypertensDecember2013Vol.21No.12 ) ( ) 8 α <90/60 mm Hg 2h 15 min 1 >20 mm Hg 100mm Hg <90mm Hg ( ) : ACEI ARB ~ 10min β 5.3 ACEI ARB β (1) : >420 : ( ) >357μmol/L( ) [92] (low densitylipoprotein [93] cholesterolldl-c) (high (2) : : densitylipoproteincholesterolhdl-c) [4] 1500mL/d () [38] (1) 8 (2) :LDL-C ARB ( ) LDL-C [39] LDL-C HDL-C (mmol/l) LDL-C HDL-C <5.18 < < ~ ~ ~ <1.04 :LDL-C:HDL-C: HDL-C LDL-C mg/dl =mmol/L mg/dl =mmol/L ACEI [94]

15 ChinJHypertensDecember2013Vol.21No [95-96] β 2 1 [97] (1) (75~100 mg/d) 1 ( 12 m/s)2 210 >10% 9 ( 2 : 50 (mmol/l) 2h <6.1 < ~<7.0 <7.8 ) < ~< (2) mg/d [4] 75mg/d (3) : (<150/90mm Hg) 2 β β [52] ( ) >65 55~60/min ACEI 3 ARB 60~70mm Hg [1] [100] 2 2~880% [98] 18% 1/2~3/4 / h 1/4 [99] (1) 9 : 2~3 ACEIARB (2) :1ACEI ARB ACEIARB ACEI ARB ( )

16 ChinJHypertensDecember2013Vol.21No [ ] :(1) [101] (2) h - () (mm Hg) (mm Hg) (obstruc- tivesleepapnea-hypopneasyndromeosahs) ACEI ARB % ( 1h ) 35mm Hg 24h (3) (4) (5) (6) 150/ 90mm Hg 140/90mm Hg [105] [102] 50%

17 ChinJHypertensDecember2013Vol.21No [ ] 24h ACEIARB [106] OSAHS OSAHS OSAHS OSAHS 50% ~ 60% [ ] : OSAHS OSAHS 30 OSAHS [ ] [111] β

18 ChinJHypertensDecember2013Vol.21No d 6d ( ) Dabl (htp:// (htp:// ( ) (htp:// (htp:// [114] : 2 5min ~3cm 1~2 4 1/d 6.2 7d 6d 5 2~3/ 1min/ d/ /85 mm Hg 140/90mm Hg /85mm Hg 1 3 7d <135/85mm Hg 6d d 1 [114] 2 : : : [115]

19 ChinJHypertensDecember2013Vol.21No : 3 140mm Hg() 90mm Hg

20 ChinJHypertensDecember2013Vol.21No ( ) :1 4~ h

21 ChinJHypertensDecember2013Vol.21No : 8 21: : : : : : : : : : 9 () 3~5

22 ChinJHypertensDecember2013Vol.21No.12 1 (mg/d) 2.5~ ~30 2~3 (Ⅰ Ⅱ) 10~20 2 Ⅲ 30~ ~ ~ ~ ~8 1 40~ ~60 2~3 4~8 1 10~ ~120 2~3 120~ ~360 3~4 90~360 1~2 6.25~ ~ ~ ~80 2 5~10 1~2 25~100 1~2 20~40 1~3 β 2.5~ ~ ~ ~50.0 1~2 30~90 2~3 5~20 1 α-β 200~ ~ ~20 1~2 25~300 2~3 2.5~ ~40 1~2 2.5~ ~ ~ ~ () 4~ ~ ( ) 25~ ~ ~ ~80 1 4~ ~40 1 α 1~10 2~3 1~20 1~2 :

23 ChinJHypertensDecember2013Vol.21No (mg) (/)(/d) 0.1/ 12.5/ 1~ / / / / / / / / 0.032/ 3.1/ 1~3 2~3 4.2/ / / / ~ / / / 6 1~2 1~2 2.5/ / / / / / 5/ / / / / 10/ ~2 5/ 10 1~2 1~2 SPC / / 10.0/ 0.8 1~2 1~2 5/ : SPC: ( )

24 ChinJHypertensDecember2013Vol.21No.12 [1] BMJ (7365):628. [J] (8): [2]. 2012[R]. : prehensivelifestylemodificationonbloodpressurecontrol:main resultsofthepremierclinicaltrial[j].jama (16): [3]AppelLJChampagneCMHarshaDWetal.Efectsofcom- [4]. lossandchangesinbloodpressure:resultsofthetrialsofhyper- [J] (1):3-22. tensionprevention.phaseⅡ[j].annintern Med (1): [5]SacksFMSvetkeyLPVolmer WMetal.Efectsonblood pressureofreduceddietarysodiumandthedietaryapproachesto stophypertension(dash)diet[j].n EnglJMed (1): [6]HooperLBartletCDaverySGetal.Systematicreview of longtermefectsofadvicetoreducedietarysaltinadults[j]. [7]HeFJMacGregorGA.Howfarshouldsaltintakebereduced [J].Hypertension200342(6): [8]. [M]//.. : 1993: [9] [R]. : [10]StevensVJObarzanekECook NRetal.Long-term weight [11]. [M]. : [12]. [M]//.. : 2001:33-37.

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26 ChinJHypertensDecember2013Vol.21No.12 (11): [51]XinXHeJFrontiniMGetal.Efectsofalcoholreductionon bloodpressure:a meta-analysisofrandomizedcontroledtrials [J].Hypertension200138(5): [52]ManciaGDeBackerGDominiczakAetal.2007guidelinesfor themanagementofarterialhypertension:thetaskforceforthe managementofarterialhypertensionoftheeuropeansocietyof Hypertension (ESH)andoftheEuropeanSocietyofCardiology (ESC)[J].JHypertens200725(6): tion.usa:lippincotwiliams& Wilkins2013:498. [54]PescateloLSFranklinBAFagardRetal.AmericanColege ofsportsmedicinepositionstand.exerciseandhypertension[j]. MedSciSportsExerc200436(3): [55]AmericanColegeofSportsMedicine.ACSM ofperindoprilinreductionofcardiovasculareventsamongpatients [M].8.. : withstablecoronaryartery disease:randomiseddouble-blind [56]. [M]. : 2005:12. [53]AmericanColegeofSports Medicine.ACSM'sresourcemanual forguidelinesforexercisetestingandprescription[m].7thedi- [57] GarberCEBlissmerBDeschenes MRetal.Quantityand qualityofexercisefordevelopingandmaintainingcardiorespirato- rymusculoskeletalandneuromotorfitnessinapparentlyhealthy adults:guidanceforprescribingexercise[j].medsciexer (7): [59]Tudor-LockeCCraigCLBrown WJetal.How manysteps/ dayareenoughforadults[j].intjbehavnutrphysact2011 8:79. [60] [M].. : [76]Park HCChoiHYKim BSetal.Antiproteinuricefectof losartaninnon-diabeticrenaldiseaseisnotdependentonacein- [61]. [M].6. : [77]AlBadarinFJAbuannadiMALavieCJetal.Evidence-based [62]FranklinSSLopezVAWong NDetal.Singleversuscom- diuretictherapyforimprovingcardiovascularprognosisinsystem- ease:theframinghamheartstudy[j].circulation (2): binedbloodpressurecomponentsandriskforcardiovasculardis- [63]ZhangYZhangXLiuLetal.Isasystolicbloodpressuretar- sesoffindingsfromtherandomizedfevertrial[j].eurheartj (12): rialhypertension[j].eurheartj201334(28): [66]GongLZhang WZhuYetal.Shanghaitrialofnifedipinein theelderly(stone)[j].jhypertens199614(10): tension.systolichypertensioninchina(syst-china)colaborative group[j].jhypertens199816(12pt1): [68]Cooper-DeHofRMGongYHandbergEMetal.Tightblood pressurecontrolandcardiovascularoutcomesamonghypertensive patientswithdiabetesandcoronaryarterydisease[j].jama (1): [J] (10): [70]EliotHLMeredithPA.PreferentialbenefitsofnifedipineGITS insystolichypertensionandincombination withrasblockade: furtheranalysisofthe'action'databaseinpatientswithangina [J].JHum Hypertens201125(1): [71]. [J] (1): tingenzymeinhibitorsinpatientswithcoronaryarterydiseaseand absenceofheartfailureorleftventricularsystolicdysfunction:an overview oflong-term randomized controled trials[j].arch Intern Med (7): [73]Fox KM.EURopeantrialOnreductionofcardiacevents with perindoprilinstablecoronaryarterydiseaseinvestigators.eficacy placebo-controledmulticentretrial(theeuropa study)[j]. Lancet (9386): [74]NAVIGATORStudyGroupMcMurrayJJHolmanRRetal. Efectofvalsartanontheincidenceofdiabetesandcardiovascular events[j].n EnglJMed (16): spective[j].clinther200729(7): get<140mm HgindicatedinalhypertensivesSubgroupanaly- [64]TaylorJ.2013ESH/ESCGuidelinesforthemanagementofarte- [67]LiuLWangJGGongLetal.Comparisonofactivetreatment andplaceboinolderchinesepatientswithisolatedsystolichyper- [72]DanchinNCucheratMThuilezCetal.Angiotensin-conver- [75]CoyleDRodbyRSorokaSetal.Cost-efectivenessofirbesar- [58]. [M]. : tan300 mggivenearlyversuslateinpatientswithhypertension andahistoryoftype2diabetesandrenaldisease:acanadianper- sertion/deletionpolymorphism[j].kidneybloodpressres (4): ichypertension[j].amjcardiol (8): datefrom the European Society of Cardiology meeting 2005: SUE-2STRIDE-2SOFAIMAGINEPREAMISIRIUS-Ⅱ andactive[j].eurjheartfail20057(6): [78]ClelandJGColetaAPLammiman Metal.Clinicaltrialsup- CARE-HFextensionstudyESSENTIALCIBIS-ⅡS-ICDIS- [79]BangaloreSAwhneySMesserliFH.Relationofbeta-blocker- inducedheartrateloweringandcardioprotectioninhypertension [J].JAm ColCardiol200852(18): ment:ananalysisofthecardiacinsuficiencybisoprololstudy Ⅱ (CIBIS-Ⅱ)trial[J].EurJHeartFail201012(6): tensivepatients:rationaledesignandbaselinecharacteristics[j]. JHum Hypertens201125(4): [65]. [80]CastagnoDJhundPSMcMurrayJJetal.Improvedsurvival 2010[J] (2): withbisoprololinpatients withheartfailureandrenalimpair- [81] Wang WMaLZhangYetal.Thecombinationofamlodipine andangiotensinreceptorblockerordiureticsinhigh-riskhyper- [82]SchmiederRESchwertfegerMBramlageP.Significanceofini- tialbloodpressureandcomorbidityfortheeficacyofafixedcom- binationofanangiotensinreceptorblockerandhydrochlorothiaz- ideinclinicalpractice[j].vaschealthrisk Manag20095:991- [69]. [83]LiuLZhang YLiu Getal.Thefelodipineeventreduction 1000.

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