高血壓 – Hypertension

高血壓(hypertension)無疑是現代人最常見的慢性病之一,而長期控制不良的高血壓也常引發其他併發症。

本次 lecture 的重點為高血壓的 (1) 流行病學與重要性, (2)定義、診斷與評估, (3) Guidelines, (4) SPRINT trial, (5) antihypertensive agents/medications, (6) Olmetec’s specialities

高血壓為全球所有導致 mortality 的危險因子中,排名第一的頭號殺手。

高血壓會增加罹患 stroke, cardiovascular disease, myocardial infarction, heart failure, atrial fibrillation, peripheral artery disease, renal failure (chronic kidney disease), dementia, premature death 的風險。

亞洲人種高血壓壓的盛行率為20-30%

2002年的研究資料顯示: 台灣居民高血壓之盛行率為23.5%, 但65歲以上的居民有58.1%患有高血壓。

15歲以上高血壓的五年發生率約為27.5‰, 男性發生率略高於女性。

Prevalence of hypertension increases with age.

Cardiovascular mortality risk doubles with each 20/10 mm Hg blood pressure increment.

Reason for lowering high blood pressure:

For each decrease in one’s mean systolic blood pressure, his/her risk of coronary heart disease mortailty falls 7% and risk of stroke mortality falls 10%.

A meta-analysis of 147 RCTs, including 464,000 subjects, concludes that every 10 mm Hg reduction in systolic pressure or 5 mm Hg reduction in diastolic pressure brings down 22% the relative risk of coronary heart disease events and 41% the relative risk of strokes.

INTERSTROKE study 發現 hypertension 是造成 stroke 最重要的危險因子, 其次才是 smoking, obesity, diabetes mellitus, alcohol drinking…

歐美人種 (caucasian) 的 cardiovascular disease mortality 以 ischemic heart disease 較 stroke 發生率高; 中日韓等東亞人種則反之(較易受到高血壓的危害)。

有研究顯示台灣人的高血壓控制率 (blood pressure control rate) 僅約有24.3%的患者有得到控制。

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