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J Hypertens:夏天高压低于110要减药!欧洲血压季节性变化共识

2020-08-11 卢芳 文韬 中国循环杂志

一年四季,血压有波动:炎热时降低,寒冷时升高。近日欧洲高血压学会相关工作组针对高血压患者季节性血压变化发布共识,指出老年人对季节性的血压变化改变影响较大。

一年四季,血压有波动:炎热时降低,寒冷时升高。但对于吃降压药的患者,夏季血压可能会降得过低,冬季血压则可能不满意。就此,近日欧洲高血压学会相关工作组针对高血压患者季节性血压变化发布共识,指出老年人对季节性的血压变化改变影响较大。

共识指出,因为冬季血压升高,血管病死亡率也增加。气温每降低1oC,死亡率增加1%。

家庭取暖和减少寒冷暴露可有效地避免老年人血压升高。室内温度每升高1oC,高血压患病率估计值降低0.2%。

血压变化的原因是,寒冷时血管收缩和外周阻力增加,而温暖环境下血管扩张和外周阻力降低。

对于血压季节性变化明显的患者,共识推荐:
1. 天气炎热出现疲劳或体位性低血压,天气寒冷时出现血压升高,应考虑可能由于季节变化所致。
2. 季节性血压变化的判定应仔细,通过反应测量诊室和诊室外血压来确认,最好是动态血压监测或家庭血压监测。
3. 在考虑季节性血压变化前应考虑其他导致血压改变的原因,比如脱水、体重减轻、治疗依从性差、服用了会使血压升高的药物或物质、饮酒、吃得过咸等。
4. 在炎热天气调整血压时,当血压降低在推荐的血压目标以下时,尤其是出现了提示过度降压的症状时,应考虑降压药物的减量。
5. 收缩压<110 mmHg(诊室、家庭或日间动态血压)应仔细考虑降压药物减量,即使患者无症状。
6. 在降压药物减量时,应考虑到患者的整体健康状况,并根据合并症的适应证推荐力度最弱的药物着手开始逐步调整治疗。
7. 减少降压药物剂量时,应确保24小时全天候充分控制血压。
8. 避免因短暂血压波动而进行的不必要的调整治疗。
9. 因季节性血压变化而调整药物剂量的患者,在气候再次变化时,应考虑到血压变化的可能性。
10. 从寒冷地区前往炎热地区旅行时,也可能会面临同季节性变化一样的问题,反之则反。
11. 对于血压季节性变化最好个体化随访,以更明确期间变化。

目前关于针对季节性血压变化治疗方面的研究较少,共识也对今后的研究方向进行了介绍:
1. 不同地理位置和不同水平气温变化水平所致的季节性血压变化是否不同,这种不同对预后影响有何差异?
2. 改善环境条件或调整药物剂量是否会改善血压季节性变化,这种调整或改善会影响预后吗?
3. 哪些环境因素或患者特征有助于区别季节性变化过于明显的脆弱人群?
4. 不同种类的降压药物对高气温或低气温下24小时血压的影响是否存在差异?
5. 哪种方案是调整季节性血压变化的最佳治疗策略?

原始出处:

George S Stergiou, Paolo Palatini, Pietro A Modesti, et al.Seasonal variation in blood pressure: Evidence, consensus and recommendations for clinical practice. Consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability.J Hypertens. 2020 Jul;38(7):1235-1243. doi: 10.1097/HJH.0000000000002341.

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    2021-02-12 feather89
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    2020-09-15 咻凡

    共识非常收益

    0

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    2020-09-09 12177770m58暂无昵称

    学习了

    0

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    2020-08-13 30397606
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    2020-08-11 liangying

    受教

    0

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