The Department of Internal Medicine of Tongji Hospital adopts the combined therapy of Chinese and Western medicine to diagnose and treat common and frequent diseases of internal medicine and all kinds of difficult and complicated diseases. Such as upper respiratory tract infection, pneumonia, acute and chronic bronchitis, asthma, coronary heart disease, angina pectoris, myocardial infarction, arrhythmia, hypertension, hyperlipidemia, acute and chronic nephritis, diabetes mellitus, especially in the diagnosis and treatment of cardiovascular and cerebral vascular diseases, there are a number of well-known experts in China who are sitting in the clinic year-round, and they enjoy high reputation in the southern part of Jiangsu Province. The department is well-equipped with foreign advanced cardiac color B ultrasound and dynamic electrocardiographic monitoring system, and recently introduced new OLYMPUS electronic endoscope, gastroscope, 14C respiratory instrument, gastrointestinal ultrasound, nano-wave therapeutic instrument and other advanced diagnostic and treatment equipment, diagnosis and treatment scope includes cardiovascular and cerebrovascular diseases, diabetes mellitus, hypertension, digestive system (all kinds of gastrointestinal disease), tumors, respiratory and other internal medicine diseases.
Studying the global hypertension representative guidelines and updating the scientific evidence of hypertension prevention and treatment
Suzhou Tongji Hospital Lu Yingshi
In 2009, the 25th anniversary of the establishment of the World Hypertension League (WHL) and the 20th anniversary of the establishment of the Chinese Hypertension League (CHL), the 2009 World Hypertension Congress (WHC2009) and the 11th CHL-sponsored International Symposium on Hypertension and Related Diseases were held in Beijing. The World Hypertension Congress 2009 (WHC2009) and the 11th International Symposium on Hypertension and Related Diseases hosted by CHL will be held from October 29 to November 1, 2009 at the Beijing International Convention Center, which makes this year's WHC an epoch-making congress. The theme of this year's WHC is "From the Physician's Office to the Bedside and the Community", with highlights ranging from blood pressure monitoring to the clinical management of hypertension in practice, assessment of lifestyle triggers of hypertension, and discussion of translational medicine. More than 4,000 delegates attended the conference, especially the conference gathered the world's top experts, is a global event in the field of hypertension, from the clinical feasibility of some countries and regions of hypertension guidelines are summarized below.
The hypertension guidelines of Europe, Japan, and Taiwan are a good reference for us, focusing on analyzing scientific evidence and emphasizing the inclusiveness, flexibility, and influence of the guidelines; the U.S. hypertension guidelines, based on scientific evidence, emphasize the operationalization of the guidelines, the promotion value, and the effectiveness of the guidelines, and point out that patients with hypertension who do not have complications or clear target-organ damage should be treated with thiazide diuretics as the initial therapeutic agent, and thiazide diuretics as the first treatment. Initial treatment drugs, thiazide diuretics, despite the adverse effects of water and salt, glucose and lipid metabolism, but in the U.S. population, clinical evidence is sufficient, antihypertensive efficacy is stronger; Canada sodium salt limit (<2.3g/d) has been included in the guidelines; Europe and the United States, Australia, and East Asia have made **** knowledge, advocate and emphasize the home blood pressure monitoring (HBPM); China's grass-roots version of the "Guidelines" in 2009 has come out in the 2010 edition. The Guidelines were revised on the basis of the 2005 version of the Guidelines, and will be discussed and revised this year and released next year, and two key points will be emphasized in order to reflect accessibility: blood pressure measurement and salt restriction.WHO recommended in October 2006 that the daily intake of sodium chloride be 5 grams (or 2 grams of sodium) as the target of nutritional intake for the population, and about 80% of the sodium in our diet comes from cooking or salted products containing high levels of salt (sauces, pickles, salted fish, salted meats, etc.). , salted fish, salted meat, etc.) Salt restriction is a major challenge to the population's habits; but cardiovascular disease has become the first cause of death in China, and about 60% of cardiovascular deaths are associated with hypertension.
From the hypertension guideline, it is not difficult to see the trend of hypertension prevention and treatment, from the previous simple blood pressure lowering to the overall cardiovascular assessment, and then formulate the optimal treatment strategy, which can be briefly summarized as follows: "three more", "four reduced", "five "
Three more pre-hypertension (high normal blood pressure); more stubborn (refractory) hypertension; more systolic hypertension with low diastolic blood pressure.
Four reduce salt; reduce (body) weight; reduce sugar; reduce (oil) fat.
Five hypertension diagnosis: continuous 24-hour ambulatory blood pressure monitoring, universal home blood pressure measurement; hypertension treatment: intensify, optimize, simplify.
Ten points
1. Setting the diagnostic criteria for non-office hypertension (≥ 135/85 mmHg) and the goal of lowering blood pressure (<125/80 mmHg). It is recommended to measure sitting blood pressure within 1 hour after waking up, after urination, before taking antihypertensive medication and breakfast, and also to measure blood pressure before going to bed in the evening. However, the desktop mercury sphygmomanometer combined with the auscultation method is still the standard method of clinical blood pressure measurement in Japan (Japan).
2. S-ABCDE lifestyle modification. Specifically, salt restriction (S), alcohol restriction (A), weight loss (B), smoking cessation (C), dietary control (D), and increased exercise (E) (Taiwan).
3, pre-hypertensive (high normal blood pressure values of 130-139 mmHg and DBP85-89 mmHg) people, there is no evidence that antihypertensive treatment can benefit, only delay the occurrence of hypertension; if diabetic patients with high normal blood pressure, and the emergence of subclinical target-organ damage (in particular, micro albuminuria or proteinuria) may be treated with caution (Europe).
4. More aggressive drug strategies. Two antihypertensive drugs are recommended for initial treatment in patients with grade 2 hypertension, whereas three antihypertensive drugs should be chosen for initial treatment in patients with grade 3 hypertension (BP ≥ 180/110 mm Hg) if this degree of hypertension is repeatedly measured (Taiwan).
5. Optimizing BP lowering is the hard way. When choosing medication, clinicians should fully understand the patient's background information, epidemiology and clinical trial results, pharmacologic properties, treatment costs, and the cost-effectiveness of long-term treatment.2009 European guidelines: diuretics in combination with ACEIs, ARBs, or CCBs are more helpful in improving prognosis, and newer studies have shown that ACEIs in combination with CCBs are more effective, and ARBs in combination with CCBs appear to be reasonably effective as well. All of the above combinations may therefore be the preferred option for combination therapy. Commonly used antihypertensive drugs in Japan include
CCB, ARB, ACEI, diuretics, and β-blockers; however, in recent years, some clinical studies have shown that β-blockers may no longer be the first choice of medication in elderly hypertensive patients without comorbidities and those with abnormalities of glucose and lipid metabolism. Our CHIEF phase study: CCB combined with ARB or diuretics are effective in lowering blood pressure.
6, antihypertensive goals: SBP<140mmHg and DBP<90mmHg. For low-intermediate risk grade 1 hypertensive patients, drug therapy should be initiated after lifestyle improvement, for grade 2-3 or high-risk grade 1 hypertensive patients should start drug therapy immediately (Europe); and Japanese guidelines: for all BP ≥ 140/ 90 mmHg and 130/80 mmHg combined with diabetes, chronic kidney disease, and myocardial infarction should be treated with antihypertensive therapy. The BP lowering target goal (<130/85mmHg) and home self-measurement BP target were added for the middle-aged population.
7, lowering blood pressure "bottom line". 2009ESH updated guidelines for the management of hypertension: some research data suggest that lowering BP to 120/85mmHg can further reduce the incidence of cardiovascular events, unless the patient has severe atherosclerotic lesions until the blood pressure is reduced to 120/85mmHg when the J-shaped curve phenomenon may not occur. , the J-curve phenomenon may not occur (Europe).
8. Blood pressure management in patients with cerebrovascular disease. Patients receiving thrombolysis in the hyperacute phase of cerebral infarction (<3 hours) were treated with blood pressure control at <180/105 mmHg; patients with non-thrombolytic treatment of cerebral infarction, SBP>220 mmHg, DBP>120 mmHg to start antihypertensive treatment; patients with cerebral hemorrhage, SBP>180 mmHg or mean blood pressure>130 mmHg side Start blood pressure reduction. Degree of blood pressure reduction, cerebral infarction patients down to 85%-90% of the pre-treatment value; cerebral hemorrhage patients down to 80% of the basal value; cerebrovascular disease in the chronic stage (after the onset of >1 month), in 1-3 months BP gradually down to 140/90 mmHg, slowly down to very important. For severe stenosis of bilateral carotid arteries and stenosis of the main arteries of the brain should pay more attention to the BP should not be lowered too low (Japan).
9. Caution is needed in antihypertensive treatment of hypertensive patients over 80 years of age who are frail or have a short life expectancy (Canada).
10, East Asian version of metabolic syndrome. Visceral fat accumulation, waist circumference ≥85 cm in men and ≥90 cm in women. and two of elevated lipids, blood pressure and blood glucose can be diagnosed and is used for risk stratification (Japan).