识别伪抗性高血压和优化利尿剂治疗在初级保健中确诊的抗性病例
1Centre for Family Medicine Family Health Team, Waterloo, Ontario.
概括
伪抗性高血压 (p-RH) 在初级保健中很常见,尿剂疗法往往未得到充分使用. 优先考虑系统的血压测量和优化利尿剂可以改善专家转诊前的管理.
科学领域:
- 心脏病学 心脏病学
- 初级医疗保健医学 一级医疗保健医学
- 高血压管理 高血压管理
背景情况:
- 抗性高血压 (RH) 影响大约10%的高血压患者.
- 伪抗性高血压 (p-RH) 由于各种因素,经常被误诊.
- 在初级保健中使用p-RH和利尿剂治疗的患病率仍未得到充分研究.
研究的目的:
- 在初级保健环境中调查p-RH的患病率.
- 评估在被认为具有RH的患者中使用最佳的利尿疗法.
- 确定在初级保健中管理RH的常见干预措施.
主要方法:
- 对被转诊至初级保健高血压诊所的患者的回顾性图表审查 (2010年1月 - 2020年9月).
- 纳入标准:年龄≥18,连续≥2次血压读数≥140/90 mmHg,尽管服用≥3种抗高血压药物.
- 系统的血压测量在高血压诊所被用于分类.
主要成果:
- 在51名转诊患者中,有41人被认为患有RH (≥140/90 mmHg服用≥3种药物).
- 在系统测量后,59% (24/41) 的这些患者被重新分类为p-RH.
- 只有29% (5/17) 的确诊的RH患者在转诊时接受了最佳的利尿剂治疗;利尿剂的启动/调整是最常见的干预措施 (47%).
结论:
- p-RH在初级保健中非常普遍,挑战了真正的RH的诊断.
- 在初级保健机构中,尿液治疗在RH患者中显著不足.
- 系统的血压测量和利尿剂优化在怀疑RH的专家转诊之前至关重要.
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