Guidelines on BP Management in CAD Updated冠心病的血压控制准则更新了

The American Heart Association, American College of Cardiology, and American Society of Hypertension have updated goals for treatment of hypertension in patients with coronary artery disease (CAD). The <140/90-mmHg BP target is reasonable for the secondary prevention of cardiovascular events. A lower target BP (<130/80 mmHg) may be appropriate in some individuals with CAD, previous myocardial infarction, stroke or transient ischemic attack, or CAD risk equivalents (carotid artery disease, peripheral arterial disease, abdominal aortic aneurysm). In patients with an elevated diastolic blood pressure (DBP) and CAD with evidence of myocardial ischemia, the BP should be lowered slowly, and caution is advised in inducing decreases in DBP to 60 years of age. In older hypertensive individuals with wide pulse pressures, lowering systolic blood pressure (SBP) may cause very low DBP values (80 years of age, a reasonable BP target is <150/80 mmHg. Octogenarians with heart failure should be checked for orthostatic changes with standing, and an SBP 美国心脏协会，美国心脏病学会和美国高血压学会更新了冠心病患者高血压治疗的目标。低于140/90毫米汞柱的目标对心血管事件的二级预防是合理的。更低的血压目标（<130/80毫米汞柱）对某些冠心病患者，曾有心梗，中风或短暂性脑缺血发作，或有相当于冠心病的其它危险因素（颈动脉病，周围动脉病，腹主动脉瘤等）者也合适。舒张压高且心肌缺血的冠心病患者，应缓慢降压，对合并糖尿病或60岁以上的任何患者降低舒张压至60毫米汞柱以下应特别小心。脉压差大的老年高血压患者，降低收缩压可能会导致非常低的舒张压值（<60毫米汞柱）。这时应该提醒临床医生仔细评估任何不良症状或体征，特别是那些心肌缺血所致。对 80岁以上的患者，合理的血压目标是低于150/80毫米汞柱。八十多岁的心衰患者，应当检查站立体位血压的变化，应该避免收缩压低于130毫米汞柱和舒张压低于65毫米汞柱。高血压一级预防的治疗准则正在制定中。来源：http://hyper.ahajournals.org/