高血压评估容量负荷建议:推荐评估吃盐量,**RAAS阻断剂+利尿剂

2019-06-15 岱西 中国循环杂志

高容量负荷,是高血压发生的重要机制,是高血压合并肾病等多种疾病的病因或危险因素,而干预容量负荷治疗高血压的显著获益已经得到验证。怎么更好地管理? 近日,北京大学第一医院霍勇教授、北京大学人民医院孙宁玲教授等14位专家发布的《高血压患者高容量负荷的评估和管理专家建议》给出了以下建议:


高容量负荷,是高血压发生的重要机制,是高血压合并肾病等多种疾病的病因或危险因素,而干预容量负荷治疗高血压的显著获益已经得到验证。怎么更好地管理

近日,北京大学第一医院霍勇教授、北京大学人民医院孙宁玲教授等14位专家发布的《高血压患者高容量负荷的评估和管理专家建议》给出了以下建议:

1. 高血压患者均应评估容量负荷状态,特别是老年高血压、难治性高血压、高血压合并糖尿病及肥胖、高血压合并慢性肾脏病、高血压合并阻塞性睡眠暂停综合征等易感人群更要格外重视。

2. 优先推荐摄盐量的评估,在有条件的医疗机构进行24 h尿钠排泄检测。基层建议:点尿、食盐问卷评分以及盐阈值评分。

在未用降压药的患者中,肾素水平测定也可辅助分析容量负荷。所有患者都应检查是否存在水肿。

3. 对容量增高的患者优先推荐低盐(摄入盐<6 g/d),肾功能好者推荐选用低钠富钾盐,并学会识别低钠食品标识;对住院患者给予低钠膳食辅助治疗。

4. 盐摄入>6 g/d的1级高血压、低中危患者首推低剂量RAAS阻断剂+利尿剂或钙拮抗剂。

对高危或极高危以及≥2级高血压,首推常规剂量RAAS阻断剂+利尿剂的治疗方案,如不能达标增加钙拮抗剂,鉴于疗效及依从性特点在联合方案中优先推荐单片固定复方制剂的使用。

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    2019-06-17 venlin
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    2019-06-16 smartxiuxiu

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