高血压急症降压,不是越快越好!中国共识

2022-05-04 中国循环杂志 网络

高血压急症的血压控制并非越快越好,也并非越低越好,需在对患者充分评估的基础上,制定个体化的治疗方案。

每10万人中就有111人因高血压急症住院,高血压患者中有1%~2%可发生高血压急症。

对于这种急诊科、心血管科及很多临床科室经常面对的急危重症之一,临床上如何更好规范处理?

针对这个问题,近日中国医师协会高血压专业委员会发布了《高血压急症的问题中国专家共识》。

对于高血压急症的定义,共识认为欧洲心脏病学会2019年使用的定义(指血压的突然、快速升高及所导致的自我调节机制失调),要比特定血压阈值定义更为准确。

不过需要强调的是,若收缩压≥220和/或舒张压≥140mmHg,则无论有无症状都应视为高血压急症。

此外,目前推荐只用高血压急症来区别需要立即治疗的情况,而不建议用“高血压亚急症”和“高血压危象/急诊高血压”表述。

高血压急症所致的高血压相关靶器官损害的核心,在于微循环损害及自身调节障碍。体格检查应重点关注心血管系统、神经系统及眼底检查。

降压速度和幅度、降压药类型都强烈依赖于临床评估

有研究显示,实际中,几乎所有血压显著升高者均入院治疗,而真正需住院治疗的高血压急症者只有40%~45%。因此,临床上需要详细评估。精准治疗,以减少不必要住院。

另一方面,降压的速度和幅度、降压药的类型都强烈依赖于临床评估。肺水肿和急性主动脉夹层患者需要快速降压,而缺血性脑卒中患者需要更为谨慎的降压策略。

高血压急症的血压控制并非越快越好,也并非越低越好,需在对患者充分评估的基础上,制定个体化的治疗方案。

高血压急症早期降压原则

①初始阶段(1h)血压控制目标为平均动脉压的降低幅度不超过治疗前水平的25%,但应根据患者基础血压及高血压相关靶器官损害程度决定;

②在随后的2~6h将血压降至较安全水平,一般为160/100mmHg左右,但需根据不同疾病的降压目标和降压速度进行后续血压管理;

③当病情稳定后,24~48h血压逐渐降至正常水平。

降压时:

①遵循迅速平稳降压、控制性降压、合理选择降压药的原则,根据不同类型特点单用一种或者联合使用静脉降压药控制性降压。

②拉贝洛尔和尼卡地平可以安全地用于所有高血压急症,并且应作为医院常备药物。硝酸甘油和硝普钠特别适用于心脏和主动脉损害的高血压急症。

来源:中国医师协会高血压专业委员会.高血压急症的问题中国专家共识.中华高血压杂志,2022,30:207-218.


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    2023-03-24 wjywjy
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    2022-05-05 ms4000000042266845

    这个降压速度自相矛盾,如果是220的血压,第一个小时降25%的话都已经165了,虽然说的第一个小时不超过25%,但还是感觉这个速度很快了

    0

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    2022-05-05 weigq

    学习

    0

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