24 2015 23 ChinJHypertens,January2015,Vol.23No.1 (2014 ) DOI:10.16439/j.cnki.1673-7245.2015.01.009 0, /,,,,,,,, 2009 (2009 ) ( ),, 10,,, 3),, 4), 2013 10,, :1, 5),, 2, 6) [ ( ), 3 (angiotensin converting enzyme inhibitors,, ( ) ACEI) (angiotensinreceptor,, blockers,arb) β ] 4,, 5, 6 7) 2 2 20/, 7 10mm Hg(1 mm Hg=0.133kPa), : 3, 2~4 1 8 8) <140/90mm Hg, 9) :, 9 ( ), 10) :, 3, 2~4, 11),, :,E-mail:wangwen5588@vip.sina.com(, 100037) 1),, 2), ( ) 12),,
2015 23 ChinJHypertens,January2015,Vol.23No.1 25 1 ( 3~6 1 ), ( ),,,, (,, ),, [1],, 2 [2] 1.1 1.1.1, [4], <140/90mm Hg,, 2.2 18 1 1.1.2 1 : ( ), 1 (mm Hg) ( ), / 2 : 2011 <120 <80, ( 1) 1.2 1.2.1 (1) 2, (2) 3 ( ) 180 ( ) 110 :1 140 <90 2 :, 3, 2 1 2 3 4 :, 35 1.2.2 (1) : 135/85mm Hg [ 130~139 ( ) 85~ 89mm Hg]2 [ (body massindex, BMI) 24.0~27.9kg/m 2 ] (BMI 28kg/m 2 ) ( ) : 90cm(2.7, ), 85cm (2.5, )3 ( )4 5 [ 100mL(2 )/d] 6 55 (2) (3) (4), [3] 1.2.3 [ 140 ( 2) ( ) 90 mm Hg] [ 2.3.2 180 ( ) 110 mm Hg],,,, [ 140 <180mm Hg 2.1, 3, 140 ( ) 90mm Hg, 120~139 ( ) 80~89 140 ( ) 90 ( ) 140~159 ( ) 90~99 2 ( ) 160~179 ( ) 100~109 135/85 mm Hg, 24h 130/80mm Hg [5] 2.3 2.3.1 : 2 ( 3 4) ( ) 90 <110mm Hg], 4 :, 2,, :2 1 1~2, :3 1 2 3
26 2015 23 ChinJHypertens,January2015,Vol.23No.1 ( ) ( ( ) ( ) ) 2 ( ) ( ), 1 2 3 7.0mmol/L :BMI 28kg/m 2 : : 5.7mmol/L,LDL-C 3.3mmol/L 90( ) 85cm( ) HDL-C<1.0mmol/L 1.7mmol/L >55( ) >65 ( ) 115μmol/L(1.3mg/dL)( ), 107μmol/L(1.2mg/dL)( ) 300mg/24h 30~300mg/24h, / 22mg/g (, 55 65 ) (2.5mg/mmol)( ), 31mg/g(3.5mg/mmol)( ) ( ) [ ( ):, ] X :PWV 12m/s :BMI: LDL-C: HDL-C: PWV: 3 (mm Hg) :140~159/90~99 2 :160~179/100~109 3 : 180/110 4 140~159 90~99 (mm Hg) 2 160~179 100~109 3 180 110 1~2 3 : 2010 3 2.4 5%~10% :1 : <30 2 ( 3 )3, 4 5 6,,, 7,
2015 23 ChinJHypertens,January2015,Vol.23No.1 27 8, 2) : <140/ >20mm Hg, 9 90mm [6-7] ( 65 ) 2.5 90mm Hg, 3) 2.5.1 :, ( ),, 4) :, 2 :, (, 2~4 ) (, ),,,,, 1~2, 4~12 3 : 4 3.2, :, 5 : 2.5.2 2 : 140/90mm Hg, 3, 4 : 2.5.3 (1) : ( )2 ( )3 : [, (low density lipoprotein cholesterol, LDL-C), (highdensitylipopro- teincholesterol,hdl-c), ] 4 (2) : :24h / 2.5.4 1, 2.5.4.1 2.5.4.2 3.3 ( ) 2.5.4.3, (, 2.5.4.4, <150/90mm Hg,, <140/ 1 3, : * 5mm Hg, 135/85mm Hg 140/90mm Hg ),, 1), 3, 3.1 1),, 10kg, 5~20 mm Hg [8-9] (, <6g/d), 2~8mm Hg
28 2015 23 ChinJHypertens,January2015,Vol.23No.1 [10],, 2) 5,, 3 5 1., <6g/d 2. (, 6g ) 3., 4.,, 1. <30%, <10%, <25g/d 50~100g/d 250g/d, 2. 3~4, 3, 3. 400~500g/d, 100g/d 4. : 1. :5~7 / : 30min/, 30min 2. 3., ( /min)=170-4. 5., 6. 30min, BMI<24kg/m 2, <90( ), <85cm( ) [11] 1. 2. 3. 4., 5., 6.,, 1.,,, 2., 3. 4. 5., 6. 7.,, : 1., <50mL/d(/d) <100mL/d(2 /d) <250mL/d(5 /d) 2., 3., 4., 5.,, :BMI: [4] 3.4 3.4.1 2, 2) :, 1) : 24h,, 24h
2015 23 ChinJHypertens,January2015,Vol.23No.1 29, 2~3 3) :, 2 3.4.3.4,, 1~2, [16] 4) : ACEI ARB 3.4.2 5 : ACEI ARB β 5, [12], α 3.4.3.5 β,, ( 80 /min) 1~2 4, 5 3.4.3, β,,, 3.4.3.6 3.4.3.1,,, [13-15], 6 3.4.4, 3.4.4.1, [17-19] 6 4,, ACEI 2 ARB 3ACEI 4ARB 3.4.3.2 ACEI, 5, 1~2, 6 β, :α ( α2 : ) / 3~4,, 3 : ACEI ARB 3.4.3.3 ARB, ACEI ARB, 1~2, 3.4.4.2 1,, ACEI 2,
30 2015 23 ChinJHypertens,January2015,Vol.23No.1 ( ) ACEI 3.4.4.3 ( 7) 3.4.4.4 6, <160/100 mm Hg, ( ) 160/ 100mm Hg, 20/10mm,, 2 / :A:ACEI ARBB: β C: ( )D: α:α ACEI: ARB ARB: F: / ACEI ( ) ( ) ( ) β :ACEI: ARB:,,, 2 3.4.4.5, ( ) ( ) ( 0 ), 0.032mg 3.1 mg 2.1 mg 4.2 mg 0.1 mg 12.5 mg 12.5mg 12.5mg 0.03mg 5.0mg 3.4.5,,,,
2015 23 ChinJHypertens,January2015,Vol.23No.1 31 7 ( ) C+D: A+C + + + + + + + + + + + C+A: + + + + A+D + + + + + + + + D+A: + + C+B: + + + + :A:ACEI ARBB: β C: ( )D: ACEI: ARB: 7, 3.4.6 (,, ), ( <160/100mm Hg),, [22],, 3.4.6.3 2,,, : 4.4~7.0 mmol/l <10.0 mmol/l (hemoglobin [20] 3.4.6.1, A1c,HbA1c)<7.0% 2013 2, ( 6.2mmol/L), 3.4.7, <5.2 mmol/l, 2 2~3 /d,, 5.2(LDL-C 3.4)mmol/L,, <4.1(LDL-C <2.6)mmol/L3,,, 4.1(LDL-C 2.6)mmol/L,, <3.1(LDL-C<2.1)mmol/L,,,, (,, ),,,,,, [21] 3.4.6.2, ( ),, (75~100mg/d),, [10 <50 /min, β >10% (>50,, ACEI, ACEI )] ARB,
32 2015 23 ChinJHypertens,January2015,Vol.23No.1, 3.4.9,,,,, 1~2, 3.4.10 20 80,,,,, 6 [4] 3.4.8 hypertensioninchina,syst-china) [13] :,, (Shanghaitrialofnifedipineintheelder- ly,stone) [14],,,,, (post-strokeantihy-, pertensivetreatmentstudy,pats) [16],,, (felodipineeventreductionstudy,fever) [6,18] 1) ( 65 ) (Chinesehyper- tensioninterventioneficacystudy,chief), : <150 mm Hg,, 85% [19] <140mm Hg 80 <150/ 90mm Hg,, <60 mm Hg, <150mm Hg, <60 mm Hg, 150mm Hg, ( ACEI ARB) 2) ACEI ARB ( ) β 3) ACEI ARB,, 4 β 4.1, 1), 4), ACEI ARB, 6), 130~ ARB ACEI β, 139/85~89mm Hg / ( )α 7) β β ACEI,3), <60 mm Hg, ( ),, 8 (systolic,,, 5) ACEI ARB, 2),,,,, 8),, 9) 120,,
8 ( ) ( ) 1. 10mg,2 /d 1. 30mg,/d 2. 10mg,/d 2. 2.5~5.0mg, 3. 10~20mg,2~3 /d 3. 5mg, 4. 1~2,2~3 /d 4. 4mg,/d 5. 12.5~25.0mg,2~3 /d 5. 20mg,1~2 /d 6. 0,/d 6. 50~100mg,/d 7. 12.5mg, 7. 80~160mg,/d 8. 1.25~2.50mg,/d 8. 40~80mg,/d 9. 12.5~25.0mg,1~2 /d 9. 2.5~5.0mg,/d 10. 1~2,2 /d 10. 2.5mg, 11. 1~2,2~3 /d 11. 10~20mg,1~2 /d 12. 10mg,/d 13. 5~10mg,/d 21. 10~20mg,2 /d 1. 2.5~5.0mg+ 40mg, 2. 20mg,2 /d 2. 30mg+ 8mg, 3. 30~60mg,/d 3. 5mg+ 12.5mg,/d 4. 5mg, 4. 10mg+ 12.5mg, 5. 2.5~5.0mg, 5. 4mg+ 12.5~25.0mg,/d 6. 0 1~2,/d 6. 2.5~5.0mg+, 7. 20mg,1~2 /d 7. 20mg+ 25mg,1~2 /d 8. 20mg,2 /d 8. 30mg+ 12.5mg,/d 9. 80mg, 9. 50mg+ 12.5mg, 10. 160mg, 10. 80mg+ 12.5mg, 11. 100mg,/d 11. 150mg+ 12.5mg, 12. 4~8mg,/d 12. 5mg+ 25mg,/d 13. 5~10mg, 13. 2.5mg+ 5mg, 14. 5~10mg,/d 14. 4mg+ 1.25mg, 15. 20mg,/d 15. 80mg+ 5mg, 16. 10~20mg,/d 16. 5mg+ 10mg,/d 17. 10mg+ 2.5mg,/d 31. 5mg+ 80mg, 1. 5~10mg+ 12.5mg, 2. 10mg+ 5mg,/d 2. 160mg+ 5mg,/d 3. 5~10mg+ 12.5mg,/d 3. 30~60mg+ 8mg,/d 4. 30~60mg+ 12.5mg,/d 4. 5mg+ 4mg, 5. 5mg+, 5. 5mg+ 5mg,/d 6. 10mg+ 12.5mg,/d 6. 5mg+ 12.5mg, 7. 4mg+ 20mg,/d 7. 100mg+ 5mg,/d 8. 20mg+ 5mg,/d :,,,, 33 2015 23 ChinJHypertens,January2015,Vol.23No.1
34 2015 23 ChinJHypertens,January2015,Vol.23No.1 4.2 4.2.1 2,, 3,, 4,,, 5, 6,,, 2013 [23] 4.2.2 ( [24] ),,, 5 2 ( 5.1 ), 3,,, ( 7) 4,, 3 1, 2~4 1 4.2.3, (2009 2 ) (, 3 1 2 3 ),, 6 4 ( )5,,,,,,, 4.2.4 9 9 (<140/90mm Hg) ( 140/90mm Hg), 3 2~4, 2, : 3, :, 5.2,,, 3 [25],,
2015 23 ChinJHypertens,January2015,Vol.23No.1 35,, 5.3 5.3.1,,,,,,,,, [26],, 5.5 (, ) 5.3.2,,,,, 2~ ( ) 3, 7d, 6d, 1,,,,,, 5~10 min,,,,, 1 min,, 5.4, 3 6 3 3 4 6.1 5, 6,, 6.2.2 6.2 2~3, 2, 6.2.1 1 3, 2 4
36 2015 23 ChinJHypertens,January2015,Vol.23No.1 5 7.2.2 6 7.2.2.1 6.2.3 : = / 2 3 100% 7 7.1, / 100% 2 7.2.2.3 3 : / / ( )/ : = / ( )/ 100% 7.2,, ( )2000, 1000,,500 2, <140/ 7.2.1 90mm Hg 400 7.2.1.1 50% (1000/2000) 25% (500/ 2000) 20%(400/2000) : = / 600 100%, : ( ) 400, 300 [ (<140/90mm Hg), ( ) 30%(600/2000), 67%(400/600), ] 50%(300/600) 7.2.1.2 (, ),,, : = / 100% 7.2.1.3 8, : = /, 100%, < 140, <90mm Hg,,, : : <140/90mm Hg, : ( 1 ),, 70% <140/90mm Hg 7.2.2.2 2 : = 2 :,,
2015 23 ChinJHypertens,January2015,Vol.23No.1 37 lossanddietarysodium reductiononincidenceofhypertension [J].Hypertension,2000,35(2):544-549. [10]XinX,HeJ,FrontiniMG,etal.Efectsofalcoholreductionon bloodpressure:a meta-analysisofrandomizedcontroledtrials [J].Hypertension,2001,38(5):1112-1117.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, [1]. 2011[M]. :.2012. [2],,,. [J]. 2157-2172.,2011,19(12):1101-1115. [3] Weber MA,Schifrin EL,White WB,etal.Clinicalpractice guidelinesforthemanagementofhypertensioninthecommunity: ternationalsocietyofhypertension[j].jclin Hypertens,2014,16 (1):14-26. [4]. 2010 : (2005)[J]., [J].,2011,19(8):701-743. [5],. [22]. 2 (2013 ) [J].,2011,39(1):3-22. astatementbytheamericansocietyofhypertensionandthein- [6]ZhangY,ZhangX,LiuL,etal.Isasystolicbloodpressuretar- sesoffindingsfromtherandomizedfevertrial[j].eurheartj, 2011,32(12):1500-1508. [7]. [J].,2013,21(12):1123-1149. 2010[J].,2010, [25],,.2 43(2):154-160. [J].,2011,19(4):336- tion,phase2[j].archintern Med,1997,157(6):657-667. [9]HeJ,WheltonPK,AppelLJ,etal.Long-termefectsofweight [11]. : [J].,2002,23(1):5-10. [12],,. [J].,2010,18(10):904-990. get<140mm Hgindicatedinalhypertensives Subgroupanaly- [8]Thetrialsofhypertensionpreventioncolaborativeresearchgroup. Efectsofweightlossandsodiumreductioninterventiononblood pressureand hypertensionincidencein overweightpeople with high-normalbloodpressure.thetrialsofhypertensionpreven-,,,,,, [13]LiuL,WangJG,GongL,etal.Comparisonofactivetreatment,,, andplaceboinolderchinesepatientswithisolatedsystolichyper- tension.systolichypertensioninchina(syst-china)colaborative group[j].jhypertens,1998,16(12pt1):1823-1829.,,,,, [14]GongLS,Zhang WH,ZhuYJ,etal.Shanghaitrialofnifedipine,,,,,, intheelderly (STONE)[J].J Hypertens,1996,14(10):1237-1245. [15],,,. - (FEVER) [J].,2010,18(5):439-443. [16]PATScolaboratinggroup.Post-strokeantihypertensivetreatment,,,, study.apreliminaryresult[j].chin MedJ (Engl),1995,108,,,,,, (9):710-717. [17]MaL,Wang W,ZhaoY,etal.Combinationofamlodipineplus angiotensinreceptorblockerordiureticsinhigh-riskhypertensive patients:a96-weekeficacyandsafetystudy[j].amjcardiovasc Drugs,2012,12(2):137-142. [18]LiuL,Zhang Y,Liu G,etal.Thefelodipineeventreduction (FEVER)study:arandomizedlong-termplacebo-controledtrial inchinesehypertensivepatients[j].jhypertens,2005,23(12): [19],,,. [J].,2009,37(8):701-707. [20]. [J].,2007,35(5):390-419. [21]. 2006,34(3):281-284. [J].,2014,6(7):447-498. [23],,. (2009 ) [J].,2010,18(1):11-30. [24] ( ),,,. 341. [26],,. [J]., 2011,16(6):435-439. :2014-12-18 :
38 2015 23 ChinJHypertens,January2015,Vol.23No.1 1 3, 24h,,, 1 1), 2),, 80% 3) 30 min, 2~3, 1 min 1 (, 6d, 6d, ) 5min,,, 4),,,,, 5), 2.5cm, 1~2 / 6), Ⅰ ( 3 ) Ⅴ ( ) Ⅰ, 24h Ⅴ <12, <130/80(24h) <135/85( ) <120/70mm Hg( ) Ⅳ ( ),,, :135/85mm Hg, 140/90mm Hg <135/85mm,, 7d, 6:00-9:00 18:00-21:00 1 1h,,, 10%~15% 7) :, (0 2 4 6 8), 0,2,4,6,8, [ (20±10)% ], 0 8) 1min, 3, 2 15 20 30min, 2 80% >5mm Hg, 3, 1 /h, 2 24h
2015 23 ChinJHypertens,January2015,Vol.23No.1 39 2 1 1 (1~3 ) >55 :LVMI X 5.7mmol/L(220mg/dL) :IMT 0.9mm LDL-C 3.3mmol/L(130mg/dL) HDL-C<1.0mmol/L(40mg/dL) <55( ) <65 ( ) 115~133μmol/L( ) (1.3~1.5mg/dL) ( ) 107~124μmol/L( ) >133μmol/L(1.5mg/dL)( ) (1.2~1.4mg/dL) >124μmol/L(1.4mg/dL)( ) (BMI 28kg/m 2 ) ( >300mg/24h) [ 90( ) 85cm( )] : 30~300mg/24h / : 22mg/g(2.5mg/mmol)( ), 31mg/g(3.5mg/mmol)( ) 7.0mmol/L(126mg/dL) 11.1mmol/L(200mg/dL) :LDL-C: HDL-C: LVMI: IMT: BMI: 3,, :,,, <6g/d :, 2 )/d, 250 ml(0.5 )/d, 50 ml, ()/d, 2 4, 5,, 3 4,, 5, 6, :, 7,,,, 2 3,, 100mL(,, (1), : :
40 2015 23 ChinJHypertens,January2015,Vol.23No.1 2 :,, 4, 3 : 120 /min 4 ( /min)=170-5 10min,,, (2) : 5~7 :, 30min : 6:00-10:00, 30min : 2:,,,, 2, 3 180/110 mm Hg, (4000 /h),, 5 6 7 :,,,, 3,, 2, 2 30min (kcal) 30~40 : ( ) 40~70 (1600m/h) ( ) (8.5km/h) ( ) 100 (20m/min) (10km/h) 120 1000~2000m/10min 175 ( ) ( ) 150 ( ) (15km/h) 180 (5% ) ( ) 200 ( ) (19~22km/h) 200~250 (50m/min) (22~26km/h) (160m/min) 300 1),, 2) 1),, 3), : 2),,, 3), 4) 4), 5),,, 5), 6), 6)(, 7), )
2015 23 ChinJHypertens,January2015,Vol.23No.1 41 4 3 3 (mg) ( /d) ( ) 10~40 2 2.5~10.0 1 20~60 2~3 30~60 1 (Ⅲ) 30~60 1 (Ⅰ Ⅱ) 10~40 2 4~8 1 2.5~10.0 1 2.5~5.0 1 ( ) 90~360 1~2 80~240 2~3 ACEI 25~150 2~3 5~40 1~2 5~80 1~2 1.25~10.00 1 4~8 1 10~40 1 5~40 1 ARB 25~100 1 80~160 1 20~80 1 150~300 1 8~32 1 ( ) 6.25~25.00 1 1.25~2.50 1 ( ) 20~80 1~2 ( ) 50~100 1~2 5~10 1~2 20~40 1~2 β 12.5~50.0 1~2 25~100 1~2 2.5~10.0 1 5~20 2 30~90 2 α1 2~20 2~3 2~4 1~2 1~20 1~2 β 12.5~50.0 2 200~400 2 α2 0.1~0.8 2 0.25 / ( ) 25~100 2 :ACEI: ARB:
42 2015 23 ChinJHypertens,January2015,Vol.23No.1 5 4 4 ( /d) 30~60mg 1~2 :, ( ) 10~20mg 2 2.5~10.0mg 1 4~8mg 1 2.5~10.0mg 1 10~20mg 2~3 10~20mg 1~2 2.5~5.0mg 1 ACEI 10~20mg 1~2 :, 12.5~50.0mg 2~3 10~40mg 1~2 10~40mg 1 5~40mg 1 ARB 25~100mg 1 ACEI 80~160mg 1 150~300mg 1 20~80mg 1 ACEI 6.25~25.00mg 1 : ( ) 1.25~2.50mg 1 : β 12.5~25.0mg 1~2 : 25~50mg 2 2.5~10.0mg 1~2 : 1~3 2~3 1~2 1~2 1-1~2 1~2 / 1~2 1 / 1 /1~2 1 / 1 1~2 1~2 2~3 1~2 1~2 ACEI :ACEI: ARB: 6 ( 150mm Hg, ACEI ) <60mm Hg 1 (>65 ), β, ACEI, β ACEI, ACEI β, ACEI ARB 3 80 ACEI β ACEI/, 160 mm Hg, ARB β ( ) β, ACEI, <150mm Hg 4 <60mm Hg, <150mm Hg, 2 ( <265μmol/L) ACEI ARB
2015 23 ChinJHypertens,January2015,Vol.23No.1 43 20/10mm Hg, ACEI 8 ARB, 8.1 3 β HbA1c<7.0% 8.2 : ( ) 2 : ( ), 5 ( ) ACEI ARB, ( ) β >133μmol/L ( ) ( ACEI/ARB <30%, ) >30%, 3, >133μmol/L(1.5mg/dL) ( >265.2μmol/L) 9, ACEI ARB 9.1,,,, 6 >220 ( ) >130 mm Hg 220/120 mm Hg 8.3,, ( ), ACEI 9.2 ARB, 120,,,,,, 7, 7.1 20,, ( 140/90mm Hg) 30/15mm Hg 2,/6h :, ( ) : 20%~25% 160/100mm Hg 7.2 7 5 5,, / /,