难治性高血压1：现状与展望
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Difficult Hypertension: As Uncontrolled as Ever, and One of the Mandated Therapies May Not Be of Much Help
Posted 02/13/2004
Introduction
This month's news highlights the difficulties faced in controlling blood pressure in hypertensive patients who have other cardiovascular risk factors, most notably diabetes. A review of National Health and Nutrition Examination Survey (NHANES) data has shown that control of blood pressure in hypertensive people with diabetes has remained at approximately the same level since the 1980s, regardless of which guideline targets are applied. The failure to achieve acceptable levels of blood pressure control in diabetic patients occurs even in clinics that specialize in managing patients with "difficult to treat" hypertension, another study has found. The same study criticizes the blood pressure targets set for managed care organizations as being too relaxed, as well as the failure of these measures to address blood pressure and diabetes as comorbidities. Target blood pressures should be set for the individual patient, taking into account other cardiovascular risk factors, according to new guidelines for the management of hypertension in patients with type 2 diabetes issued recently by the International Federation for Diabetes (European region).
Intervals between follow-up visits in the treatment of hypertensive patients, usually recommended at 3-6 months, may not be so important as previously thought, according to a Canadian study. Another generally accepted view, that angiotensin-converting enzyme (ACE) inhibitors are superior to other antihypertensive drug classes in preventing congestive heart failure in patients with primary hypertension, in fact remains unproven, according to the authors of a recently published meta-analysis of 6 major clinical trials.
National surveys from 2 major but contrasting nations, the United States and the People's Republic of China, reveal very different patterns of hypertension prevalence and control. Data obtained by the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, show that in the United States, one of the richest nations in the world, the prevalence of high blood pressure has continued to increase, as have other cardiovascular risk factors such as high blood cholesterol, diabetes, and obesity. On the other hand, the InterASIA study has found that in China, one of the most populous nations on Earth, there are low proportions of people who are aware of their hypertension, receiving treatment for their hypertension, or whose blood pressure is being controlled, posing an urgent challenge to instigate national education programs to coordinate the effort of prevention, detection, and treatment of hypertension.
Posted 02/13/2004
Introduction
This month's news highlights the difficulties faced in controlling blood pressure in hypertensive patients who have other cardiovascular risk factors, most notably diabetes. A review of National Health and Nutrition Examination Survey (NHANES) data has shown that control of blood pressure in hypertensive people with diabetes has remained at approximately the same level since the 1980s, regardless of which guideline targets are applied. The failure to achieve acceptable levels of blood pressure control in diabetic patients occurs even in clinics that specialize in managing patients with "difficult to treat" hypertension, another study has found. The same study criticizes the blood pressure targets set for managed care organizations as being too relaxed, as well as the failure of these measures to address blood pressure and diabetes as comorbidities. Target blood pressures should be set for the individual patient, taking into account other cardiovascular risk factors, according to new guidelines for the management of hypertension in patients with type 2 diabetes issued recently by the International Federation for Diabetes (European region).
Intervals between follow-up visits in the treatment of hypertensive patients, usually recommended at 3-6 months, may not be so important as previously thought, according to a Canadian study. Another generally accepted view, that angiotensin-converting enzyme (ACE) inhibitors are superior to other antihypertensive drug classes in preventing congestive heart failure in patients with primary hypertension, in fact remains unproven, according to the authors of a recently published meta-analysis of 6 major clinical trials.
National surveys from 2 major but contrasting nations, the United States and the People's Republic of China, reveal very different patterns of hypertension prevalence and control. Data obtained by the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, show that in the United States, one of the richest nations in the world, the prevalence of high blood pressure has continued to increase, as have other cardiovascular risk factors such as high blood cholesterol, diabetes, and obesity. On the other hand, the InterASIA study has found that in China, one of the most populous nations on Earth, there are low proportions of people who are aware of their hypertension, receiving treatment for their hypertension, or whose blood pressure is being controlled, posing an urgent challenge to instigate national education programs to coordinate the effort of prevention, detection, and treatment of hypertension.
