衞生署 高血壓指引 牀
目錄 1. 引言... 2. 高血壓的定義及分類... 3. 初步評估... 3.1... 3.2... 3.3... 3.4... 4. 防治高血壓... 4.1... 4.2... 4.3... 4.4... 5. 轉介... 5.1... 5.2... 附錄 I 血壓測量儀器... 附錄 II 跟進 附錄 III 白袍高血壓的動態血壓監測... 附錄 IV 證據級別 ( 取自美國醫護政策及研究機構 )... 附錄 V 肥胖的分類 ( 世 國際肥胖問題工作組 2000)..
附錄 VI 診所供應的降血壓藥物列表及價格... 參考資料... 衞生署專業發展及質素保證轄下臨牀審核及指引小組的成員 名單... 免責聲明... 索取指引...
1. 引言 1 1995 1996 2 10 9 1 160 95 12 16 1 140-159 90-94 6% 8% 66% 71% 34% 29% 2002 牀 牀 2. 高血壓的定義及分類 18 着 2003 類別收縮壓 ( 毫米汞柱 ) 舒張壓 ( 毫米汞柱 ) <120 <80 120-139 80-89 140-159 160 90-99 100 前期高血壓 120-139 80-89 7 III B P.4
3. 初步評估 3 3.1 目的 i. 1 ii. iii. 2 3 表 1 心血管疾病的誘因 表 2 高血壓的可識別成因 (Primary aldosteronism) <60 (55 65 ) (Cushing s syndrome) ( 55 (Pheochromocytoma) 65 ) 表 3 靶器官的損傷 3.2 身體檢查 i. ii. iii. iv. v. vi. P.5
3.3 檢驗 i. ii. iii. iv. 3.4 初步評估表格 6 高血壓初步評估表填寫日期 : 身分證號碼 : 輸入 :( ) 健康教育 : 身體檢查 : 檢驗 : / N A / / / -/ /+/++/+++ 誘因 : 併發症 : P.6
4. 防治高血壓 3 4.1 治療目標 <140/90 <130/80 4.2 高血壓防治流程表 未達理想血壓 (<140/90 毫米汞柱 ) 如兼患糖尿病或慢性腎病, 則須達至 <130/80 毫米汞 ) 第一階段第二階段 4.4.2 140-159 ( >160 >100 90-99 ) 酶 β 酶 酶 β 調校至理想劑量或附加其他藥物, 直至達到理想血壓 考慮約見專治高血壓的專科醫生 P.7
3 4.3 生活調適的防治方案 * 生活調適建議收縮壓的 大概減幅 10 18.5-22.9 5-20 8-14 24 2-8 100 2.4 6 4-9 30 2 2-4 1 30 24 10 3 80 1 10 * P.8
3 4.4 高血壓的藥物治療 4.4.1 酶 β 23 Ib A <140/90 <130/80 Ib A 20/10 4.4.2 牀 建議使用的藥物 強制性適應症 * 利尿劑 β 受體阻斷劑 血管收縮素轉化酶抑制劑 血管收縮素受體阻斷劑 鈣通道阻斷劑 甲多基巴 臨牀試驗基礎+ ACC/AHA, MERIT-HF COPERNICUS, CIBIS, SOLVD, AIRE, TRACE, ValHEFT, RALES ACC/AHA Post-MI, BHAT, SAVE, Capricorn, EPHESUS ALLHAT, HOPE, ANBP2, LIFE, CONVINCE NKF-ADA, UKPDS, ALLHAT NKF, Captopril, RENAAL, IDNT, REIN, AASK PROGRESS * 牀 牀 P.9
4 4.4.3 i. (diuretic) β (beta-blocker) ii. (diuretic) 酶 (ACEI) iii. (calcium antagonist) 吡 β (beta-blocker) iv. (calcium antagonist) 酶 (ACEI) v. α (alpha-blocker) β (beta-blocker) ABCD i. 酶 ACEI β Beta-blocker ii. Calcium antagonist Diuretic i. ii. β (verapamil) iii. 酶 5. 轉介 8 5.1 急症室轉介 i. >130 ii. iii. iv. >130 20 Adalat Retard 1 2 220/120 Adalat (a) 140/90 20 (b) P.10
8 5.2 i. ii. 30 iii. 20 iv. v. 附錄 I 一血壓測量儀器 1.1 血壓計 iii. i. ii. 1.2 檢查水銀血壓計 i. ii. iii. iv. 迹 v. a. b. 200 10 c. 10 2 d. 2 P.11
1.3 檢查電子血壓計 i. ii. iii. 5 2. 血壓測量技巧 vii. i. 5 ii. iii. iv. v. vi. a. b. c. d. viii. 30 60 ix. 30 x. 2 xi. xii. xiii. 30 P.12
3. 血壓測量須知 3.1 測量人員須知 i. ii. 2 iii. 2v iv. 2 xii v. a. 10 8-10 b. 10% vi. 2 x vii. viii. 3.2 受測者的因素 i. ii. iii. 1 iv. v. 1 2 vi. vii. viii. ix. P.13
附錄 II 跟進 3,4,5,6 1. 血壓如達目標並保持穩定, 則可每隔不多於 6 個月檢查一次 2. 跟進評估 ( 不多於 6 個月 ) 3,4,5,6,8 5,8 4,8 * 4,5,8 4,5,8 3. 每年最少檢查一次 5,9 4. 視乎適應症進行檢查 # *8,9 # 8,9 # 8,9 酶 衞 4 5 EL 9 酶 4 6 P.14
流程表 日期 血壓 體重指數 / 體重 尿蛋白 按照指示服藥 藥物副作用 飲食不當 致病誘因 吸煙 缺乏運動 評估及防治 ( 腎功能 血脂 空腹血糖 心電圖等 ) 跟進 P.15
附錄 III 白袍高血壓的動態血壓監測 14-21 IIb 1. 引言 (1) 20% (2) 24 140/90 <135/85 2. 目的 TM-2420 3. 程序 (1) i. >140/90 <140/90 ii. iii. iv. v. 但應包括長期服用這些治療藥物 而病況穩定的病人 vi. P.16
(2) (3) (4) (5) 附錄 IV 證據級別 ( 取自美國醫護政策及研究機構 ) 級別證據類別 ( 根據美國醫護政策及研究機構 1992 年分類法 ) Ia Ib IIa IIb III IV 牀 建議級別 級別建議 ( 根據美國醫護政策及研究機構 1994 年分級法 ) A (Ia Ib) B (IIa IIb III) C (IV) 牀 牀 牀 P.17
附錄 V 肥胖的分類 ( 世國際肥胖問題工作組 2000 年分類法 ) 25 類別體重指數 ( 公斤 / 平方米 ) 兼患疾病的風險 <18.5 牀 18.5-22.9 23 I II 23-24.9 25-29.9 30 衞 附錄 VI 類別藥物名稱 ( 商標 ) 價格 ( 港元 ) Natrilix 0.065 Lasix 0.05 Dyazide 0.22 0.30 Aldactone 0.261 β Tenormin 500.089 1000.143 Betaloc 500.06 1000.1 Inderal 100.024 40 0.037 酶 Capoten 250.224 Renitec 50.4 10 0.5 200.8 Zestril 50.36 10 0.48 Acertil 40.277 Adalat 50.133 10 0.148 Adalat 200.114 Retard Norvasc 52.963 10 5.5 Plendil 2.51.947 5 2.54 105.089 α1 Minipress 10.112 2 0.294 Hytrin 11.3 2 1.6 Aldomet 1250.3 2500.176 P.18
參考資料 1. Whelton P K. Epidemiology of hypertension. Lancet 1994;344:101-106. 2. Janus E.D. Hong Kong Cardiovascular Risk Factor Prevalence Study 1995-1996. 3. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, 2003. US Department of Health and Human Services. National Institutes of Health, National Heart, Lung and Blood Institute. 4. Chalmers J et al. 1999 World Health Organization - International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens, 1999, 17:151-185. 5. Ramsay LE et al. Guidelines for management of hypertension report of the third working party of the British Hypertension Society, 1999. J Human Hypertens 1999; 13:469-592. 6. Department of General Practice & Primary Health Care, University of Leicester (Eli Lilly). Management of Hypertension In Primary Care. 7. Vasan RS, Larson MG, Leip EP, et al. Assessment of frequency of progression to hypertension in nonhypertensive participants in the Framingham Heart Study: A cohort study. Lancet 2001;358:1682-6 8. HT Working Group (1999-2000). Department of Health Hypertension Protocol for GOPD. 9. Working Group on Clinical Practice Guidelines for Integrated Health Service for the Elderly (Dec, 2000). Clinical Practice Guidelines for Elderly Health Centres 3rd Edition. 10. U.S. Preventive services Task Force. Counseling to Prevent Tobacco Use (March 1994). Screening for Hypertension. Screening for Obesity. 11. Stuant et al. Primary prevention of cardiovascular disease. Clinical Evidence Issue 5 2001 p77-80. 2001 BMJ Publishing Group. 12. Michael Pignone, Cynthia D Mulrow. What are the elements of good treatment for hypertension? Evidence based management of hypertension. BMJ 5 May 2001;322:1107-1109. 13. Chan S. The management of hypertension in the acute setting. HK Pract. 2001;23:92-99. 14. O Brien E. et al. Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society. BMJ 22 April 2000; 320:1128-34. 15. The National High Blood Pressure Education Program Coordinating Committee. National High Blood Pressure Education Program Working Group Report on Ambulatory Blood Pressure Monitoring. Archives of Internal Medicine 1990; 150:2270-80. 16. Grin J.M. et al. Management of Hypertension after Ambulatory Blood Pressure Monitoring. Annals of Internal Medicine 1993; 118:833-837. 17. Appel L.J. et al. Ambulatory Blood Pressure Monitoring and Blood Pressure Self-Measurement in the Diagnosis and Management of Hypertension. Annals of Internal Medicine 1993; 118:867-882. 18. American College of Physicians. Automated Ambulatory Blood Pressure Devices and Self-Measured Blood Pressure Monitoring Devices: Their Role in the Diagnosis and Management of Hypertension. Annals of Internal Medicine 1993; 118:889-892. P.19
19. O Connor D.B. et al. Are occupational stress levels predictive of ambulatory blood pressure in British GPs? An exploratory study. Family Practice 2001; 18:92-94. 20. McAlister F.A. et al. Measurement of blood pressure: an evidence based review. BMJ 2001; 322:908-11. 21. O Brien E. et al. ABC of hypertension: Blood pressure measurement. BMJ 5 May 2001; vol.322: 1110-1114. 22. Family Medicine working group on Hypertension (2003), Department of Health Hypertension Protocol (First Edition). 23. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker against diuretic: The Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT) JAMA 2002;288:2981-97. 24. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Brag GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001;344:3-10. 25. The Asia-Pacific perspective: Refinding obesity and its treatment (2000). P.20
生署專業發展及質素保證轄下臨牀審核及指引小組的成員名單 組長 : 高血壓指引第二版的統籌人員 : 成員 : 1. 2. 3. 4. 堃 5. 聯絡人 : 衞 1 2557 5542 charmaine@hannahcheung.com johnhli@netvigator.com 附註 2004 12 P.21
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