Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Can J Cardiol. 2011 Jul-Aug;27(4):415-433.e1-2. doi: 10.1016/j.cjca.2011.03.015.
We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2011. The major guideline changes this year are: (1) a recommendation was made for using comparative risk analogies when communicating a patient's cardiovascular risk; (2) diagnostic testing issues for renal artery stenosis were discussed; (3) recommendations were added for the management of hypertension during the acute phase of stroke; (4) people with hypertension and diabetes are now considered high risk for cardiovascular events if they have elevated urinary albumin excretion, overt kidney disease, cardiovascular disease, or the presence of other cardiovascular risk factors; (5) the combination of an angiotensin-converting enzyme (ACE) inhibitor and a dihydropyridine calcium channel blocker (CCB) is preferred over the combination of an ACE inhibitor and a thiazide diuretic in persons with diabetes and hypertension; and (6) a recommendation was made to coordinate with pharmacists to improve antihypertensive medication adherence. We also discussed the recent analyses that examined the association between angiotensin II receptor blockers (ARBs) and cancer.
我们更新了 2011 年成人高血压诊断、评估、预防和治疗的循证推荐。今年的主要指南变化如下:(1)建议在沟通患者的心血管风险时使用相对风险类比;(2)讨论了肾动脉狭窄的诊断测试问题;(3)增加了对急性脑卒中期间高血压管理的建议;(4)患有高血压和糖尿病的人,如果存在尿白蛋白排泄增加、显性肾脏疾病、心血管疾病或其他心血管危险因素,现在被认为存在心血管事件的高风险;(5)在糖尿病和高血压患者中,与 ACE 抑制剂和噻嗪类利尿剂联合使用相比,ACE 抑制剂和二氢吡啶钙通道阻滞剂 (CCB) 的联合使用更优;(6)建议与药剂师合作以提高降压药物的依从性。我们还讨论了最近分析血管紧张素 II 受体阻滞剂 (ARB) 和癌症之间关联的分析。