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[GWICC2009]William Louis谈降压策略

作者:国际循环网   日期:2009/10/15 15:18:00

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International Circulation: Blood pressure reduction is the key point in reducing cardiovascular risks. So how low should we lower the blood pressure? Is “as low as possible” a good strategy?《国际循环》:降压是减低心血管风险的关键,血压应该降到多低?“尽可能低”是个好策略吗?

International Circulation:  Blood pressure reduction is the key point in reducing cardiovascular risks. So how low should we lower the blood pressure? Is “as low as possible” a good strategy?
《国际循环》:降压是减低心血管风险的关键,血压应该降到多低?“尽可能低”是个好策略吗?

Williams Louis:  I don’t know if anyone can give you a complete answer to that question.  The guidelines at the moment state that in patients who are over 65 years of age we should lower the blood pressure below 140/90 mmHg.  Although that may seem quite low for an elderly group, it has been demonstrated quite clearly to reduce the risk of stroke and heart attack.  It is also quite important in preventing this epidemic of heart failure which is occurring in the elderly.  In people younger than that the targets are, in my mind, closer to 130/85 mmHg.  If you are a diabetic, particularly a diabetic with proteinuria, you should attempt to get the blood pressure below 120/80 mmHg.  It is not always possible to achieve these targets and, in the end, you may have to balance blood pressure reduction targets on the basis of the incidence of side effects.  Particularly in elderly patients where hypertension can be as serious problem because autonomic function and the autonomic nervous system do not function so well, people tend to get more serious and resistant hypertension.  This can make it more difficult to achieve target pressures. 

Williams Louis:  我不知道是否有人能给你圆满的答复。目前的指南指出对于56岁以上的患者,我们应该将血压降低到140/90 mmHg以下。尽管这对于老年群体来说似乎很低了,但事实证明这能明显减少中风和心脏病发作的机率。预防心衰的流行也很重要,老年中很常见。我记得小于65岁的人,目标血压应该接近130/85mmHg。如果你是糖尿病患者,尤其是合并蛋白尿的糖尿病患者,你应该尽量将血压降到120/80 mmHg以下。并不是总能达到这些目标。最终,你也许不得不在降压目标和副作用的发生间寻找平衡。尤其是老年人,高血压能成为严重的问题,因为随着年龄增长,自主神经系统功能衰退,会逐步发展成严重高血压和顽固性高血压。很难达到目标血压。

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