201312 21 12ChinJHypertensDecember2013Vol.21No.12 1123 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) 2011-09 ( ) 2012-05 15 (4) 2012-2015 2013 (5) (2) 41% ( ) 350 70% 50% 40%~50% 15%~30% 2012 2.66 40% 10% 2012-07-01 30% 20 ( ) 2013-04-19 (3) 2013-06-19 : : ( ) E-mail:wangwen5588@126.com 中国高血压患者教育指南 编撰委员会 2013-09
1124 201312 21 12ChinJHypertensDecember2013Vol.21No.12 1 1.1 () 1.2 1.2.1 1 2 1 : 1 2 1 2 ( ) ( ) ( ) 3~7d ( 1~3 ) 1min : 1 min 1.2.2 1: 1 h/d 0.5~ : 1.0kg 1( ) 2( 2:2 ) 3( ) 4( ) ( ) 1/ 1.3 <140/90 mm Hg 1.3.1 (1) : (1mm Hg=0.133kPa) (2) :
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1125 : (1) 10min (2) : ( (3) ) ( ) (4) ( ) ( (5) ) : 2 1.3.2 (1) 1. 2. 3. 2.1 (2) <120/80mm Hg 1.3.3 ( ) 30~ 40mm Hg ( ) ( ) 1.4 1.4.1 (1) 24h 1~3 (2) (3) (6) 2.2 (4) 3 140mm Hg() [1] 90mm Hg 1.4.2 3 90%
1126 201312 21 12ChinJHypertensDecember2013Vol.21No.12 3 (mm Hg) <120 <80 120~139 () 80~89 140 () 90 1 ( ) 140~159 () 90~99 2 ( ) 160~179 () 100~109 3 ( ) 180 () 110 140 <90 ( ) (bodymassin- dexbmi) ( ) 2.3 : / : : ( 55 ) (ankle-armbloodpressurein- 6 1 dexabi) (pulse wavevelocity PWV) 2.4 1959 5%2002 19% 1000 201215 24% 2.66 [2] 24h ( ) 2.9 CT 350 (41%) 10 1 700 250 3 2.5 1. : / 2. [1] 70%~80% 2.6 : ( ) : : CT :Doppler CT 20% ~30% :
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1127 [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 3.7 1.89g WHO 4.7g 4 9g 6g 22% ( ) 16% 3.2 / 2. 70% 50% : 3.0 2.5 3. [10-11] 1 2.6 [20] 2 : 3 4 3.5 2000 1. 5 [12-13] 3.3 5%~10% 4.1 [1] 2 (1) : 3 : 3.4 : : :
1128 201312 21 12ChinJHypertensDecember2013Vol.21No.12 20mm Hg 10mm Hg 1 [23] 50 50 [24] (2): 250 [2] [25] 70% [26-27] ( ) : ( ) : 2~15mm 3000 4.2 : ( ) : [1] / 24h [28] 1/35 4.2.1 [21] (3) : 3 4 5 10~15 4 [22] (4) : (5): >55() >65() (6) 115/75 mm Hg (7) : ( ) (mm Hg) 1 2 3 ( ( ( 140~159 160~179 180 90~99) 100~109) 110) 1~2 3 / 5 12m/s
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1129 4.2.2 ( ) 20 80-90 6 20 10 7 [29] 10 3 : : 7 ( BMI ) (6) : : 10 (%) <10% 10%~20% >20% 1: 58 160mm HgBMI27kg/m 2 6.24mmol/L 7 / (/58) 4 (160mm Hg) 5 BMI(27kg/m 2 ) 1 (6.24mmol/L) 1 () 2 6 () 1 10 14 : () (mm Hg) 35~<40 0 <120-2 -2 40~<45 1 120~<130 0 0 45~<50 2 130~<140 1 1 50~<55 3 140~<160 2 2 55~<60 4 160~<180 5 3 60 5 1 180 8 4 BMI(kg/m 2 ) (mmol/l) <24 0 <5.2 0 24~<28 1 5.2 1 28 2 0 0 0 0 2 1 1 2 : ( ) :BMI: 14 6 10 27.7% 5 [330-31] 5.1 : 10ICVD (%) 10ICVD (%) -1 0.3-2 0.1 0 0.5-1 0.2 1 0.6 0 0.2 2 0.8 1 0.2 3 1.1 2 0.3 4 1.5 3 0.5 5 2.1 4 1.5 6 2.9 5 2.1 7 3.9 6 2.9 8 5.4 7 3.9 9 7.3 8 5.4 10 9.7 9 7.3 11 12.8 10 9.7 12 16.8 11 12.8 13 21.7 12 16.8 14 27.7 13 21.7 15 35.3 16 44.3 17 52.6 :BMI: ICVD: 1. 2. 3. 4. / 5.1.1 5.1.1.1 [32]
1130 201312 21 12ChinJHypertensDecember2013Vol.21No.12 [32-33] [33-34] 3 1 150 6g 3g [35] 2 3 <25g( [36] ( ) [3539] 5.1.1.3 (1) : [37] :1 2g( 2g ) 6g( 6g) 2 (2) : 3 :1 2 4 3 C 4 5 4cm 400~500g(8 ~1 5g6 ) 1~2 7 5.1.1.2 [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) : 5.1.1.4 :1 (2) : 2 3 : 4 : 2% (3) : / :1 : 2 :
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1131 3 : 0.5~1.0kg6 4 1 5%~10% 5.1.2 / [40] : 3 1 2 ( )3 ( ) 5.1.3 (1)BMI [41] : 5.1.3.1 15 3.5 [45] / BMI : BMI= (kg)/ 2 (m 2 ) BMI :BMI18.5~<24.0kg/m 2 24.0~<28.0kg/m 2 28.0kg/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 4008885531 4mm 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 32.5% 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 : 120 4 =170- [56] 5 10min (2) : 2~3 48h (4) : (5) : [3551-52] 10000 [58-59] 5.1.4 (6) : 30~50mm Hg [53] 10 min 5.1.5 10~22h [54]
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1133 :1 2 3 4 5 [1] 6 7 40%~50% 8 ( ) [61] 5.1.6 24h 50% [60] 5.1.7 (1) : (2) : 24h 2~3/d (3) : 30% ~40% 5.2 70% 1. : [62] SPC 2. : 3. : <140/90mm Hg ( <150/90mm Hg 4. : 4~12 5.2.1 15% ~30% [1] 5.2.2 (4) : ) 5.2.3 (1) 5. (2) 24h (angiotensinconvertingenzymeinhibitors ACEI) (angiotensinrecep- (3) torblockersarb) β (4) (single-pilcombinationspc) 5.2.4 (1) : 6. <140/90 mm Hg
1134 201312 21 12ChinJHypertensDecember2013Vol.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] 5.2.5 ( ) 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
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1135 [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: 5.2.9 [87-88] SPC / / [89] 5.2.7 1~2 1 3 1 3 5.2.10 1 140/90 mm Hg 24h (1) : 10% 1% ~5% : β (3) ACEI/ARB [90-91] 5.2.8 3 5.2.11 10% ) ( ) )5 (2) ( ) ( / :1 ( >20/10mm Hg 30%
1136 201312 21 12ChinJHypertensDecember2013Vol.21No.12 ) ( ) 8 α <90/60 mm Hg 2h 15 min 1 >20 mm Hg 100mm Hg <90mm Hg ( ) : ACEI ARB 5.3.2 5~ 10min β 5.3 ACEI ARB β 1 5.3.1 5.3.3 (1) : >420 : ( ) >357μmol/L( ) [92] (low densitylipoprotein [93] cholesterolldl-c) (high (2) : : densitylipoproteincholesterolhdl-c) [4] 1500mL/d () [38] (1) 8 (2) :LDL-C ARB 5.3.4 ( ) LDL-C [39] LDL-C HDL-C (mmol/l) LDL-C HDL-C <5.18 <3.37 1.04 <1.70 5.18~6.19 3.37~4.12 1.70~2.25 6.22 4.14 1.55 2.26 <1.04 :LDL-C:HDL-C: HDL-C LDL-C mg/dl 0.0259=mmol/L mg/dl 0.0113=mmol/L ACEI [94]
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1137 [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 <7.8 6.1~<7.0 <7.8 )3 430 80 <7.0 7.8~<11.1 7.0 11.1 (2) 5.4 100 mg/d [4] 75mg/d (3) : 5.4.1 1 (<150/90mm Hg) 2 β β [52] ( ) >65 55~60/min ACEI 3 ARB 60~70mm Hg 5.4.2 [1] 5.3.5 [100] 2 2~880% [98] 18% 1/2~3/4 / 5.4.3 2h 1/4 [99] (1) 9 : 2~3 ACEIARB (2) :1ACEI ARB ACEIARB ACEI ARB ( )
1138 201312 21 12ChinJHypertensDecember2013Vol.21No.12 5.5 5.5.1 [1103-104] :(1) [101] (2) 10 10 2h - () (mm Hg) (mm Hg) 3 105 69 104 68 4 107 70 105 69 5 110 71 107 71 6 112 73 110 72 7 115 74 112 73 8 117 76 115 74 9 119 77 117 76 10 120 78 118 77 11 122 78 121 77 12 124 78 122 78 13 125 79 123 78 14 127 79 123 78 15 129 79 123 78 16 130 79 123 78 17 132 80 124 78 6.0 1. 2. 3. (obstruc- tivesleepapnea-hypopneasyndromeosahs) ACEI ARB 5.5.2 65 49% ( 1h ) 35mm Hg 24h (3) (4) (5) (6) 150/ 90mm Hg 140/90mm Hg [105] 5.5.3 [102] 50%
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1139 6.1 [112-113] 24h ACEIARB [106] 6.1.1 5.5.4 OSAHS OSAHS OSAHS OSAHS 50% ~ 60% [107-108] :1 - - 2 3 6.1.2 OSAHS OSAHS 30 OSAHS [109-110] [111] β 6 1. 2.
1140 201312 21 12ChinJHypertensDecember2013Vol.21No.12 10 6.1.3 7d 6d 6.2.2 2010 ( ) Dabl (htp:// www.dableducational.org) 6.1.4 (htp://www.bhsoc.org/index.php) ( ) (htp://www.bhli.org.cn) (htp://www.chl-bha.org) [114] 6.2.3 1 : 2 5min 3 40 2~3cm 1~2 4 1/d 6.2 7d 6d 5 2~3/ 1min/ 1. 6 1d/ 1 6.2.4 2. 135/85 mm Hg 140/90mm Hg 3 3. 135/85mm Hg 1 3 7d <135/85mm Hg 6d 6.2.5 1d 1 [114] 2 : 6.2.1 1 : : [115]
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1141 6.2.6 : 3 140mm Hg() 90mm Hg 7.1.3 6.2.7 1 2 3 1 7.1.4 7 1. 2. 7.1.5 7.1 7.1.1 7.1.6 2 3 7.1.2
1142 201312 21 12ChinJHypertensDecember2013Vol.21No.12 50 90 7.1.12 7.1.7 7.1.13 7.1.8 7.1.9 7.1.15 ( ) 7.2 7.1.10 :1 4~12 2 3 7.1.14 7.1.11 4 5 6 24h
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1143 : 8 21: : 100 1000 1000 3 : 3 170 : : : : : : : 9 () 3~5
1144 201312 21 12ChinJHypertensDecember2013Vol.21No.12 1 (mg/d) 2.5~10 1 10~30 2~3 (Ⅰ Ⅱ) 10~20 2 Ⅲ 30~60 1 30~60 1 1.25~5.00 1 2.5~10.0 1 4~8 1 40~80 2 20~60 2~3 4~8 1 10~20 1 40~120 2~3 120~240 1 90~360 3~4 90~360 1~2 6.25~25.00 1 12.5~25.0 1 0.625~2.500 1 1.5 1 20~80 2 5~10 1~2 25~100 1~2 20~40 1~3 β 2.5~10 1 50~100 2 47.5~190.0 1 12.5~50.0 1~2 30~90 2~3 5~20 1 α-β 200~600 2 12.5~50.0 2 10~20 1~2 25~300 2~3 2.5~40.0 2 5~40 1~2 2.5~40 1 1.25~20.0 1 10~40 1 1.25~5.00 1 () 4~8 1 2.5~10.0 1 ( ) 25~100 1 80~160 1 150~300 1 20~80 1 4~32 1 20~40 1 α 1~10 2~3 1~20 1~2 :
201312 21 12ChinJHypertensDecember2013Vol.21No.12 1145 2 (mg) (/)(/d) 0.1/ 12.5/ 1~2 1 0 12.5/ / / / / / / / 0.032/ 3.1/ 1~3 2~3 4.2/ 2.1 50.0/ 12.5 1 1 100.0/ 12.5 1 1 80.0/ 12.5 1~2 1 150.0/ 12.5 1 1 40.0/ 12.5 1 1 10/ 6 1~2 1~2 2.5/ 25.0 1 1 10.0/ 12.5 1 1 4.00/ 1.25 1 1 / / / 5/ 80 1 1 5/ 10 1 1 10.0/ 12.5 1 1 5.0/ 12.5 1 1 / 10/ 20 1 1~2 5/ 10 1~2 1~2 SPC / / 10.0/ 0.8 1~2 1~2 5/ 10 1 1 : SPC: ( )
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