2015CHEP高血压管理建议指南的更新要点

The2015CHEPRecommendationsWhat’snewinthetreatmentofhypertension?What’sstillreallyimportant?2015HypertensionCanada•Mission:–Advancinghealththroughthepreventionandcontrolofhighbloodpressureanditscomplications.•Vision:–Canadianswillhavethehealthiestbloodpressureintheworld.2015Evidence-basedAnnualRecommendations•Canadahastheworld’shighestreportednationalbloodpressurecontrolrates•CHEPisknownasthemostcrediblesourceforevidence-basedchronicdiseasemanagementrecommendations,withannualupdates,awell-validatedreviewprocessandeffectivedisseminationtechniquesacrossCanada20152015CHEPRecommendationsTaskForce2015HypertensionCanadaKnowledgeTranslationOrganizationalChartRecommendationsTaskForce2015HypertensionCanada’sAnnualKTCyclefordevelopingmanagementrecommendationsAdaptedfromGrahamID,Logan,J.,HarrisonMB,Straus,S.,Tetroe,JM,Caswell,W.etal.(2006).Lostinknowledgetranslation:Timeforamap?JournalofContinuingEducationinHealthProfessions,26,13-24.2015CHEP2015RecommendationsWhat’snew?•Assessclinicbloodpressuresusingelectronic(oscillometric)monitors•Thediagnosisofhypertensionshouldbebasedonout-of-officemeasurements•Themanagementofhypertensionisallaboutglobalcardiovascularriskmanagementandvascularprotectionincludingadviceandtreatmentforsmokingcessation•Treatmentofatheroscleroticrenalarterystenosisisprimarilymedical2015What’sstillimportant?•KnowtheBPthresholdandtreattotarget•Adoptinghealthybehavioursisintegraltothemanagementofhypertension•Themostimportantstepinprescriptionofantihypertensivetherapyisachievingpatient“buy-in”CHEP2015Recommendations2015PopulationSBPDBPDiabetes13080Highrisk(TODorCVriskfactors)14090Lowrisk(noTODorCVriskfactors)160100Veryelderly*(≥80yrs.)160NAUsualbloodpressurethresholdvaluesforinitiationofpharmacologicaltreatmentTOD=targetorgandamage*Thishighertreatmenttargetfortheveryelderlyreflectscurrentevidenceandheightenedconcernsofprecipitatingadverseeffects,particularlyinfrailpatients.Decisionsregardinginitiatingandintensifyingpharmacotherapyintheveryelderlyshouldbebaseduponanindividualizedrisk-benefitanalysis.2015PopulationSBPDBPDiabetes13080Allothers80yrs.(includingCKD)14090Veryelderly(≥80yrs.)150NATreatmentconsistsofhealthbehaviour±pharmacologicalmanagementRecommendedTreatmentTargetsInpatientswithcoronaryarterydiseasebecautiouswhenloweringbloodpressureifdiastolicbloodpressuresare60mmHg2015What’sstillimportant?•KnowtheBPthresholdandtreattothetarget•Adoptinghealthybehavioursisintegraltothemanagementofhypertension•Themostimportantstepinprescriptionofantihypertensivetherapyisachievingpatient“buy-in”CHEP2015Recommendations2015ImpactofhealthbehaviourmanagementonbloodpressureInterventionSystolicBP(mmHg)DiastolicBP(mmHg)Dietandweightcontrol-6.0-4.8Reducedsalt/sodiumintake-5.4-2.8Reducedalcoholintake(heavydrinkers)-3.4-3.4DASHdiet-11.4-5.5Physicalactivity-3.1-1.8Relaxationtherapies-5.5-3.5ClinicalGuideline:Methods,evidenceandrecommendationsNationalInstituteforHealthandClinicalExcellence(NICE)May20112015HealthBehaviourManagement:SummaryInterventionTargetReducefoodswithaddedsodium→2000mg/dayWeightlossBMI25kg/m2Alcoholrestriction2drinks/dayPhysicalactivity30-60minutes4-7days/weekDietarypatternsDASHdietSmokingcessationSmokefreeenvironmentWaistcircumferenceMen102cmWomen88cm2015What’sstillimportant?•KnowtheBPthresholdandtreattothetarget•Adoptinghealthybehavioursisintegraltothemanagementofhypertension•Themostimportantstepinprescriptionofantihypertensivetherapyisachievingpatient“buy-in”CHEP2015Recommendations2015Adherencetoantihypertensivemanagementcanbeimprovedbyamulti-prongedapproach•Encouragegreaterpatientresponsibility/autonomyinregularmonitoringoftheirbloodpressure•Educatepatientsandpatients'familiesabouttheirdisease/treatmentregimensverballyandinwriting•Useaninterdisciplinarycareapproachcoordinatingwithwork-sitehealthcaregiversandpharmacistsifavailable•Encouragingadherencetotherapybyhealthcarepractitioner-basedtelephonecontact,particularly,overthefirstthreemonthsoftherapy2015Adherencetoantihypertensivemanagementcanbeimprovedbyamulti-prongedapproach-II•Assessadherencetopharmacologicalandhealthbehaviourtherapiesateveryvisit•Teachpatientstotaketheirpillsonaregularscheduleassociatedwitharoutinedailyactivitye.g.brushingteeth.•Simplifymedicationregimensusinglong-actingonce-dailydosing•Utilizesinglepillcombinations•Utilizeunit-of-usepackaginge.g.blisterpackaging2015CHEP2015RecommendationsWhat’snew?•Monitorbloodpressuresinclinicusinganelectronic(oscillometric)device•Thediagnosisofhypertensionshouldbebasedonout-of-officemeasurements•Themanagementofhypertensionisallaboutglobalcardiovascularriskmanagementandvascularprotectionincludingadviceandtreatmentforsmokingcessation•Treatmentofatheroscleroticrenalarterystenosisisprimarilymedical2015Criteriaforthediagnosisofhypertensionandrecommendationsforfollow-up:overviewMeasurementusingelectronic(oscillometric)upperarmdevicesispreferredoverauscultationABPM:AmbulatoryBloodPressureMeasurementAOBP:AutomatedOfficeBloodPressureHBPM:HomeBloodPressuremeasurementOBPM:OfficeBloodPressuremeasure