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新诊断高血压的患者，应该检查哪些项目？

2017-09-19 郭艺芳 郭艺芳心前沿

高血压决策诊断
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等，这都有助于医生更为准确的制定治疗决策，特别是确定是否需要服用阿司匹林和他汀。

1. 检查有无心脑肾疾病

伴或不伴心脑肾疾病，血压控制目标是不一样的。例如伴有冠心病或肾脏疾病的高血压患者，应将血压控制在130/80 mmHg以下，而不是140/90 mmHg。

另外，伴有不同疾病的高血压患者应该选择的降压药也是不同的。例如，伴有冠心病时应首先选择β受体阻滞剂，伴有慢性肾病时则应首先选择普利类或沙坦类药物。

2. 检查心电图与心脏超声

这两项检查有助于评估是否患有冠心病、左心室肥厚等心脏疾患。

3. 检查血肌酐与尿蛋白

了解有无合并肾脏病变。

4. 检查血糖

合并糖尿病时应将血压控制在130/80 mmHg以下，并且应该首先选择普利类或沙坦类降压药物。

5. 检查血脂

血脂检测结果有助于确定是否需要服用他汀。高血压患者常合并血脂异常。不同高血压患者低密度脂蛋白胆固醇的理想水平是不一样的。

如果只患有高血压，不伴有其他疾病，把低密度脂蛋白胆固醇控制在3.4 mmHg以下即可；如果高血压合并糖尿病，则应将低密度脂蛋白胆固醇控制在1.8 mmol/L以下。这样的患者多需要接受他汀治疗。

6. 检查有无颈动脉或下肢动脉疾病

这些大血管存在明显狭窄（≥50%）时也应该更为积极的控制血压，并应用他汀和阿司匹林治疗。

7. 其他

除上述各项外，确诊高血压后还应告诉医生自己是否吸烟、身高体重是多少、父母有无心血管病等，这都有助于医生更为准确的制定治疗决策，特别是确定是否需要服用阿司匹林和他汀。

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createdTime=Wed Sep 20 10:25:02 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245942, encodeId=8c352459423c, content=厉害厉害--学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCSvgHPvuQp0g9YLQuk8Dv2tO2J8cA1nBOPWOR46Rv1IMw309iaVI4zibSE52MibbXtA54h46besGYv6vpQfsUHpY9TaCKOVRmm2A/0, createdBy=14511949364, createdName=尹玉伟, createdTime=Wed Sep 20 09:12:29 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245911, encodeId=2d0824591175, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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    2018-05-29 rgjl

    #新诊断#

    0

  2. 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    2017-09-22 lofter

    学习了.感谢分享

    0

  3. 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    2017-09-21 大爰

    学习并分享!!

    0

  4. 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createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Sep 20 07:50:10 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245894, encodeId=add5245894aa, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Wed Sep 20 07:12:38 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245877, encodeId=44942458e72b, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Sep 20 06:55:53 CST 2017, time=2017-09-20, status=1, ipAttribution=)]
    2017-09-20 yfjms

    学习了

    0

  5. 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createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Sep 20 07:50:10 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245894, encodeId=add5245894aa, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Wed Sep 20 07:12:38 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245877, encodeId=44942458e72b, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Sep 20 06:55:53 CST 2017, time=2017-09-20, status=1, ipAttribution=)]
    2017-09-20 圣艮山

    学习了不少事情!

    0

  6. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Sep 20 06:55:53 CST 2017, time=2017-09-20, status=1, ipAttribution=)]
    2017-09-20 戒馋，懒，贪

    谢谢分享.学习了

    0

  7. 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createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Sep 20 07:50:10 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245894, encodeId=add5245894aa, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Wed Sep 20 07:12:38 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245877, encodeId=44942458e72b, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Sep 20 06:55:53 CST 2017, time=2017-09-20, status=1, ipAttribution=)]
    2017-09-20 尹玉伟

    厉害厉害--学习了

    0

  8. 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createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Sep 20 07:50:10 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245894, encodeId=add5245894aa, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Wed Sep 20 07:12:38 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245877, encodeId=44942458e72b, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Sep 20 06:55:53 CST 2017, time=2017-09-20, status=1, ipAttribution=)]
    2017-09-20 Y—xianghai

    学习了新知识

    0

  9. 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createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Sep 20 07:50:10 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245894, encodeId=add5245894aa, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Wed Sep 20 07:12:38 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245877, encodeId=44942458e72b, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Sep 20 06:55:53 CST 2017, time=2017-09-20, status=1, ipAttribution=)]
    2017-09-20 半夏微凉

    学习了谢谢分享

    0

  10. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Sep 20 06:55:53 CST 2017, time=2017-09-20, status=1, ipAttribution=)]
    2017-09-20 明月清辉

    谢谢分享.学习了

    0

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高血压是卒中的一个重要危险因素，但是单一的血压测量可能不足以用于长期卒中风险的预测。不同类型的高血压变化曲线与不同的卒中风险相关。但由于样本量小，目前已有研究未能检验不同的卒中亚型。2017年9月，《Hypertension》的一项研究评估了社区居住成人的长期血压（BP）模式与脑出血和脑梗死风险之间的关联。

抗高血压药的用药禁忌

高血压病是中老年人常见的一种慢性疾病，除了改善患者的饮食习惯及生活方式外，应使用抗高血压药物进行长期或终生治疗。抗高血压药物种类较多，如应用不当不仅达不到治疗目的，更有可能引起多种副作用或不良反应。下面就来介绍下临床上常用的一线降压药的用药禁忌及注意事项。敲黑板，划重点！一、利尿剂其降压机制是利钠排水，使高血容量负荷降低而发挥降压作用。包括袢利尿剂、噻嗪类利尿剂以及保钾利尿剂。代表药物：氢氯噻嗪、

Hypertension：拉贝洛尔与硝苯地平对妊娠期慢性高血压疗效比较！

目前，关于妊娠期慢性高血压患者的抗高血压药物的选择的随机对照试验十分有限。近期，一项发表在杂志Hypertension上的研究对这一问题进行了评估，旨在比较拉贝洛尔和硝苯地平，以及不同种族对治疗效果的影响。 此项研究在英国4个中心（2014年8月至2015年10月）招募了慢性高血压孕妇（妊娠12周+0-27周+6）。开放标签一线抗高血压治疗随机分为：拉贝洛尔（200-1800 mg/d）

JAMA Intern Med：强化降压可降低慢性肾病患者死亡风险

强化动脉压控制可显著降低高血压并慢性肾病患者的全因死亡风险

高血压等慢性病低龄化明显 专家主张合理膳食

当前，我国居民膳食结构不合理问题较为突出，造成高血压、糖尿病等与膳食相关的慢性病患病率攀升，且低龄化趋势明显。对此，专家建议，居民应更加重视合理膳食在慢性病防控中的作用，提升预防慢性病发生和发展的能力。

Hypertension：顽固性高血压患者的代谢组学研究

大约9％至12％的高血压患者出现顽固性高血压（RH）。长期暴露于次最佳血压控制状态会导致器官损伤和心血管风险。螺内酯是目前治疗最有效的药物之一，但不是所有的患者都有治疗反应，并且其副作用不可忽略。目前，对RH的相关发病机制知之甚少。近期，一项发表在杂志Hypertension上的研究旨在确定尿液中的代谢改变。此外，还研究了代谢物预测螺内酯反应的潜在能力。研究者们从29例RH患者和13例假性RH患者