高血压——初级保健中成人高血压的治疗——部分更新

Abstract
Introduction:
This National Institute for Health and Clinical Excellence (NICE) guideline provides recommendations for the primary care management of raised blood pressure (BP). It includes recommendations on approaches to identifying patients with persistently raised BP and managing hypertension (including lifestyle advice and use of BP-lowering drugs).

Methods:
This NICE guideline on the management of hypertension is based on the best available evidence. A multidisciplinary Guideline Development Group carefully considered evidence of both the clinical effectiveness and cost effectiveness of treatment and care in developing these recommendations. The draft guideline was then modified in the light of 2 rounds of extensive consultation with the relevant stakeholder groups, including National Health Service organizations, health care professionals, patient/ caregiver groups, and manufacturers.

Results:
The previous NICE recommendations for measuring BP, instituting and maintaining lifestyle modifications, and estimating cardiovascular risk have not changed; only those pertaining to drug treatment have been updated. Drug therapy should be offered to patients with persistent high BP of 160/100 mm Hg or more and patients at raised cardiovascular risk (10-year risk of cardiovascular disease of 20% or more or existing cardiovascular or target-organ damage) with persistent BP of more than 140/90 mm Hg. In hypertensive patients aged 55 years or older or black patients of any age, the first choice for initial therapy should be either a calcium-channel blocker or a thiazide-type diuretic. For this recommendation, black patients are considered to be those of African or Caribbean descent, not mixed-race, Asian, or Chinese. In hypertensive patients younger than 55 years, the first choice for initial therapy should be an angiotensin-converting enzyme inhibitor (or an angiotensin-II receptor antagonist if an angiotensin-converting enzyme inhibitor is not tolerated). An annual review of care should be provided to monitor blood pressure, provide patients with support, and discuss their lifestyle, symptoms, and medication.

Conclusions:
The British National Health Service will use these guidelines and their associated audit parameters to assess and improve the quality of care provided by general practitioners.