视频播放 Video Play

[ACC2009]即将公布的JNC 8指南会有哪些亮点?—Norman Kaplan、Suzanne Oparil、Henry R. Black专访
作者未知 编辑:张家程 时间:2009/5/15 19:14:00    加入收藏

Norman Kaplan

Dr. Norman Kaplan: Now that has been a philosophy but I think we realize there is no need for hurry. When people's blood pressures are reduced markedly, they often become weak, fatigued, and dizzy.  If those symptoms can be prevented than it is more likely that patients will stay on therapy. So unless the patient is really in major distress at the moment, and with a very high pressure, then going slowly rather than more rapidly is probably the best way to manage those patients. If we lower the blood pressure slowly, patients will be more likely to remain symptomatic and not be bothered by the medication and, therefore, hopefully will be more willing to stay on the medication.


Suzanne Oparil
JNC 8指南委员会主席

Dr. Suzanne Oparil: Getting patients under rapid control is satisfying to the patient because in the US most patients have home blood pressure machines so they are monitoring their pressure and if they don't see a change in a few days they think that you are not a good doctor and the drug is not working. Very fast is very bad. We don't use for example, capsule nifedipine is not used anymore because it drops the pressure too fast and there have had problems with heart attacks and strokes with that. We prefer drugs that are true once a day, that act over a long period of time.


Henry R. Black

Dr. Henry R. Black: In the past there has been confusion, I think, between what we would call the urgent treatment of hypertension, or immediate treatment and the prompt treatment.  We think from carefully analyzing recent clinical trials, that the rate that you lower blood pressure can make a big difference on outcomes.  And I am not talking hours, certainly not minutes; I am not even talking days.  I am talking about weeks and months. Start a drug, one drug if you wish, or one therapy if you wish, not switch to something else but rather to add. We know that drugs with their different mechanisms, on a platform of lifestyle modifications, will have the best outcomes.  The VALUE study in particular, showed that if you didn't get blood pressure down within the first three months, that the stroke rate stayed high, you didn't catch up until the very end of that study. 

Black博士:以往我们混淆了紧急降压和快速降压的概念。在仔细分析最新的临床试验数据之后,我们发现,降压速度不同时,患者的转归有巨大差异。这里我说的不是几分钟或几小时,也不是几天,而是在几周或几个月内使患者的血压达标。起始治疗应用单一药物,必要时也可以应用联合治疗。我们可以增加药物剂量,但是最好不要轻易换药。应用作用机制不同的抗高血压药物,在生活方式干预的基础上,能够取得最佳疗效。需要特别提到的是VALUE研究, 结果显示,如果在试验的前3个月没有把血压降下来,那么卒中的发生率居高不下。直到试验结束时依然如此。

  点击排行 Top Hits

关于本站 | 设为首页 | 加入收藏 | 站长邮箱 | 友情链接 | 版权申明

声明:国际循环网( www.icirculation.com)对刊载的所有文章、视频、幻灯、音频等资源拥有全部版权。未经本站许可,不得转载。

国际循环 版权所有  2008-2020 icirculation.com  All Rights Reserved