Hypertension steps down and treats Jointly use medicine and make individuals a key point with blood pressure up to standard

Hypertension steps down and treats Jointly use medicine and make individuals a key point with blood pressure up to standard
Hypertension steps down and treats Jointly use medicine and make individuals a key point with blood pressure up to standard
Ministry of Public Health issue " whether China hypertension prevented and cured the guide " as far back as 2005 ' Hereafter referred to as the guide) Revised edition, and the edition at the basic level has already been issued and implemented for more than 1 year in 2009 of this guide, the guides of these two editions have offered for prevention and cure of crowd hypertension of our country and sought unity of standard. Prevention and cure of hypertension have new development in recent years, it is reported hypertension guide of our country put out the redaction. Does the principle that the clinician should follow in resisting the drug therapy of hypertension have those changes? The concrete case that can't contain in the face of the guide, with what kind of tactics to reply? Bringing these questions, the reporter has interviewed China and cured the professional committee's Vice Chairman of SCTE's hypertension, centre Professor Sun NingLing of heart of the People's Hospital of Peking University and cardiovascular hypertension of disease hospital outside the mound of Chinese Academy of Medical Sciences treat centre chief physician Jiang XiongJing, invite them to make an introduction on tactics and treatment means of new prevention and control of this field. The medicine has many kinds of Jiang male Beijing to tell reporters to optimize the scheme, at present to jointly employ, in stepping down change of tactics, pay attention to optimizing and jointly treating clinically. To treatment of hypertension, it is an absolute principle to make blood pressure up to standard, there is only blood pressure steady and up to standard, it is the oldest that the patient benefits. Discover, the form medicine treatment of hypertension can only get about efficient 50% at most, and two or more of depressor is jointly used, the ones that can get 60%~70% at least are efficient, the ones that are even up to about 80% are efficient at most. Jointly step down and treat to lie in, follow and choose to have the different types medicine in coordination with complementary function the principle that jointly uses medicine compared with the therapeutic advantage of single medicine, every dosage of medicine is reduced, medicine bad reaction and side effect are thereupon reduction, make, step down result and person who submit to raise obviously. "The choice of the medicine in the face of stepping down numerously, while uniting the formulation of healing solution, stepping down should reflect ' optimize ' the principle to treat. " Sun NingLing says. First of all, unite the administration to want rationally. Cause by the fact that it is many kinds of mechanisms that the human body produces hypertension, have the intersection of capacity and the intersection of reliance and mechanism, renin - systematic (RAS) angiotensin Activate mechanism,etc.. So rational depressurization administration controls the blood capacity, but also can. The rational union administration still embodies in, can make blood pressure control better, make the bad reaction reduce lowerly at the same time. Because unite in the scheme, every bad reaction of a depressor can be neutralized through the function of another medicine. For example, calcium resists pharmaceuticals (CCB) short of moneyly Itself can cause some slight edema of patient, and jointly use angiotensin inhibitor (ARB) Can correct the hydropic symptom of CCB, thus lower the incidence of bad reaction. So, " optimize " that jointly treats Show, step down rationality, rationality and low grade characteristic of the bad reaction to step down curative effect of mechanism at first. Secondly, say, characteristic and therapeutic demand of disease are come to treat and make up according to Sun NingLing, this is too " Optimize " One way. In special number, should also consider the protection of the human organ while stepping down. So, as to different diseases or condition, there should be different unions. NingLing Sun amalgamate patient of hypertension, point out for example, step down medicine take, consider comprehensive factor while using with diabetes, for example heavy dose of diuretic can lower blood pressure, caused the abnormal state of the candy supersession or sour rising of the urine at the same time, this kind of treatment has not reflected " Optimize " Tactics. Generally speaking, the prior choice ARB or ACEI (angiotensin invertase inhibitor) among the diabetics Kind of depressor, because consider these medicines can protect renal organ and heart organ, improve metabolic disorder of candy, reduce the proteinuria. But the intersection of hypertension and patient of diabetes single treatment enough medicine up to standard blood pressure totally often, so some patients also need to unite depressor of other types to treat. Fall in the blood medicine receptor blockade pharmaceutical of �� because will aggravate the abnormal state of the candy supersession, can't be as a gleam of treatment either. So, adopt ARB (or ACEI) Add first kind of diuretic and then ' Or CCB) Can reflecting" Optimize " Characteristic. Third, step down and can also reflect to treat that drop at all-weather blood pressure optimally. Have some patient belong to night increasing blood pressure ' It is not spoon type blood pressure) ,Can adopt two kinds of scheme treatments: A scheme is to adopt a long-efficiency depressor to reduce blood pressure at night; Another scheme to unite two long-efficiency depressor, early obeying one by late all. The latter not only can control blood pressure in the morning, but also can control blood pressure at night, guarantee a patient is normotensive in a whole day, not obviously fluctuating, so this is " optimized " One way. Some long-efficiency depressor might not be taken in the morning, can adjust medicine time according to the characteristic of patient's blood pressure, this is a time principle of therapeutics, " optimize " too Treat a kind of embodiment of the tactics. In addition, Sun NingLing introduces, some patients' blood pressure fluctuation is great, namely call it the big variability of blood pressure, this kind of phenomenon sees more the serious the elderly of arteriosclerosis. Depressor which improves blood pressure with effectual variability can be chosen preferably, such as CCBs. There are international researches that have already verified, CCB unites ACEI depressor, the result is obvious in improving variability of blood pressure, can reduce the fluctuation of blood pressure effectively, has obtained the good clinical test result. It unites healing solutions of ACEI to be to improve the intersection of blood pressure and one optimization of variability, step down scheme jointly based on CCB. Sun NingLing points out, in a word, according to the requirements of the demand for disease treatment, own rationality of medicine and requirement of the blood pressure shape, step down optimally tactics right away embody in patient's blood pressure not only can be up to standard of, accomplish the all-weather steady decline; Reduce effectively or improve the organ to damage, increase the medicine bad reaction or not; Reduce the blood vessel of heart brain incident more. Step down, valued for up to standard, the blood pressure level is lowered so as to also the more reduce the more low, dangerous, but Jiang XiongJing points out, the normal physiological blood pressure of the human body is in fluctuating up and down constantly in one day 24 hours, and the normotensive range has certain differences among the crowds of different characteristics, each patient's blood pressure drops to some intensity and is most suitable for not seeking unity of standard. Jiang grand Beijing explains, lower the emergence that blood pressure can reduce the cardiovascular disease, but blood pressure is excessively reduced will cause the blood flow of important internal organs to pour into insufficiently and causing the harmful effects too, even cause mortality to rise. So, there is " J clicks " between human blood pressure level and danger of cardiovascular vessel . " J clicks " Mean that when the hypertension patient's blood pressure drops a certain point, it will cause the incident incidence of blood vessel of heart brain not to lower to further lower blood pressure Rise instead. XiongJing Jiang point out have something to do, discover in recent years, compatible some the intersection of cardiovascular vessel and hypertension patient of disease, blood pressure up to standard? �, enzyme of shelf, dash for ward Yao cut difficult the intersection of �� and Cong record the intersection of �� and head cut the intersection of �� and Cong difficult, record Man of �� nurse Zhao Mian print R all of a sudden Mediocre difficult �֤� Song crack of �֤� cellar Private the intersection of flute and strange the intersection of acute communicable diseases and Pu write Bi �J order. "But want, find same in all crowd applicable J it orders to be very difficult generally. " Jiang XiongJing emphasizes, " the key lies in, to different crowds, it is different that blood pressure is controlled a bit more most appropriate. For example there are narrow patients or narrow hypertension patients of serious arterial carotis of coronary heart disease of serious coronary artery that, it is all right to keep blood pressure up to standard. Step down, lead to the fact important internal organs pour into enough, appear the function damage perhaps further, even threaten the life. If conversely, make the ideal level that blood pressure reduces to the mercury column of 120/80 millimetres safe as to the simple hypertension patient, favorable to blood vessel and renal protection of heart brain. " In addition, also include a lot of other factors to the influence that blood pressure J clicks. Such as the ethnic group's influence, the blood vessel situation of white race, black kind of persons or yellow stores in the blood vessel and bears the difference of pressures because of genetic difference, J some levels will be probably different; The intersection of weight and influence of level again, 100 people with 60 people of weight of weight needed by it heart fight producing amount to be obviously different, the former certainly needs the heart to fight and pump more blood to supply the need of whole body each time, so blood pressure J of the crowd with high weight will inevitablely be higher than the crowd low in weight to click; Again, such as like the influence of age, the old crowd lowers because of the aging elasticity of blood vessel, the blood flow to be satisfied the internal organs is poured into, J of its systolic pressure will be higher than the young crowd when being clicked. "So, the existence that J clicks is only an academic concept, in fact people are unable to find a fixed number value generally suitable for all hypertension crowds. " Jiang XiongJing says in this way. Then, can't confirm at present the crowd's J clicks in a situation that it's very kind of you to say so, what kind of blood pressure level should be reached to treat to step down? Jiang XiongJing thinks, this individual who involves hypertension treats. It steps down to be should first up to standard, want, meet requirement of " China hypertension prevent and cure the guide ": The ordinary hypertension patient's blood pressure is dropped to the mercury column of 140/90 millimetres. Secondly, following individuals should become the clinical common understanding to treat the principle under the guidance of following medical science of the card. Not only lower blood pressure but also can't excessively step down blindly. On drug therapy, to the simple systolic phase hypertension patient of old age, try hard to first choose to reduce depressor with effectual systolic pressure, if long-efficiency calcium ion resists pharmaceutical, diuretic short of moneyly. In clinical practical operation, recommend monitoring 24-hour blood pressure, understand blood pressure fluctuation in an all-round way, hypertension, the intersection of blood pressure and supreme value and most low value,etc. from the morning, carry on administration change in view of the above for instance. Sun NingLing thinks too, the control goal of blood pressure should be adjusted according to disease characteristic and real condition. According to the stipulations of guide, diabetic's blood pressure should be smaller than the mercury column of 130/80 millimetres. However, in fact the clinical trial that the European guide to hypertension in 2009 puts forward shows, the patient's blood pressure that much diabetes amalgamates hypertension though has not reached under the mercury column of 130/80 millimetres, but he still benefits from stepping down and treating; And some patient blood pressure though drop to the mercury column of 130/80 millimetres, can not benefit. Can benefit to endanger the patient's blood pressure to certain extent when being lowered while it means these highing, the standard that the guide provides is not fit for every patient. Jiang XiongJing points out, in common cases, the clinician can follow various guides and carry on treating; And when in the face of the special case, especially there is complicated patient who amalgamates disease, doctor should can according to the intersection of actual conditions and correct analysis also, make, choose to the intersection of patient and really beneficial, healing solution and medicine of individual, avoid imitating the guide mechanically, this's the dialectical disease therapeutic method.


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