特定人群中高血压的管理:一篇综述
Abbal Koirala1, Samir C Gautam1, Ahsan Aslam2
1Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Annals of translational medicine
|November 10, 2025
概括
高血压管理需要针对黑人,老年人和患有慢性病或移植后的人个性化策略. 在这些人群中,量身定制的方法对于最佳的血压控制和降低心血管风险至关重要.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
背景情况:
- 高血压是一个全球性的健康问题,在特定人群中患病率更高,包括自认黑人,老年人和慢性病 (CKD) 或移植患者.
- 自认黑人个人中高血压患病率的差异与健康的社会决定因素和APOL1遗传变异有关,增加了损伤的易感性.
- 老年人经常出现孤立的缩性高血压 (ISH),而CKD和脏移植接受者在血压 (BP) 管理方面面临着不同的挑战.
研究的目的:
- 审查在不成比例地受影响的人群中高血压的独特挑战和当前管理策略.
- 检查特定患者群体中高血压的患病率,潜在机制和治疗考虑因素.
- 强调个性化护理对最佳血压控制和心血管风险降低的重要性.
主要方法:
- 综合目前关于特定人群高血压管理的证据.
- 检查流行数据,潜在的病理生理机制和治疗指南.
- 对临床试验结果的审查,例如静脉压干预试验 (SPRINT).
主要成果:
- 高血压的患病率在不同的人群中存在显著差异:57.1%的自认黑人与43.6%的非西班牙裔白人; ~70%的个人>65岁; 80-85%的CKD患者; ~85%的脏移植接受者.
- 虽然过去的建议在黑人成年人中偏爱 thiazide 利尿剂和通道阻断剂 (CCB),但目前的做法强调具有可比效力的组合疗法.
- 目前的指导方针 (例如,KDIGO 2021) 建议特定的BP目标 (例如,CKD的SBP<120 mmHg,移植接受者的SBP<130/80 mmHg),首选的药物包括RAAS阻断剂和二皮里丁CCB,考虑到AKI和正静性低血压等风险.
结论:
- 在多样化和高风险人群中,个性化治疗策略对于管理高血压至关重要.
- 了解遗传倾向 (APOL1变种) 和健康的社会决定因素对于解决差异至关重要.
- 遵守最新的指导方针和仔细考虑患者特异性因素是改善结果和降低心血管风险的关键.
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