大江 发表于 2019-1-1 00:01:05

高血压


自动臂血压计显示动脉高血压(显示收缩压158 mmHg,舒张压99 mmHg,心率80次/分钟)

高血压(HTN或HT),也称为高血压(HBP),是一种长期的医学病症,其中动脉血压持续升高。高血压通常不会引起症状。然而,长期高血压是冠状动脉疾病,中风,心力衰竭,心房颤动,外周血管疾病,视力丧失,慢性肾病和痴呆的主要危险因素。

高血压被分类为原发性(必需)高血压或继发性高血压。大约90-95%的病例是原发性的,由于非特异性生活方式和遗传因素而被定义为高血压 。增加风险的生活方式因素包括饮食中过量的盐,体重过重,吸烟和饮酒。 其余5-10%的病例被归类为继发性高血压,定义为由于可识别的原因导致的高血压,例如慢性肾病,肾动脉狭窄,内分泌紊乱或使用避孕药。

血压由两个测量值表示,即收缩压和舒张压,分别是最大和最小压力。对于大多数成年人来说,静息时的正常血压在100-130毫米汞柱(mmHg)收缩压和60-80 mmHg舒张压范围内 。对于大多数成年人,如果静息血压持续在130/80或140/90 mmHg以上,则会出现高血压。 不同的数字适用于儿童。 24小时内的动态血压监测似乎比基于办公室的血压测量更准确 。

生活方式的改变和药物可以降低血压,降低健康并发症的风险。生活方式的改变包括减肥,体育锻炼,减少盐摄入量,减少酒精摄入量和健康饮食。如果生活方式改变不充分,那么就会使用血压药物。最多三种药物可以控制90%的人的血压。用药物治疗中度高动脉血压(定义为> 160/100 mmHg)与预期寿命有关。治疗血压在130/80 mmHg和160/100 mmHg之间的效果不太明显,一些评论发现有益 ,其他人发现效果不明确 高血压影响全球16%至37%的人口。 2010年,人们认为高血压占所有死亡人数的18%(全球940万人)。

视频: ↓ 什么是高血压?
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目录
1 症状和体征
1.1 继发性高血压
1.2 高血压危象
1.3 怀孕
1.4 儿童
2 原因
2.1 原发性高血压
2.2 继发性高血压
3 病理生理学
4 诊断
4.1 成年人
4.2 儿童
5 预防
6 管理
6.1 目标血压
6.2 改变生活方式
6.3 药物
6.4 抗性高血压
7 流行病学
7.1 成年人
7.2 儿童
8 结果
9 历史
9.1 测量
9.2 识别
9.3 治疗
10 社会与文化
10.1 意识
10.2 经济学
11 研究
12 其他动物
12.1 猫
12.2 狗
13 参考文献

体征和症状
高血压很少伴有症状,其鉴别通常是通过筛查,或寻求医疗保健以解决无关的问题。一些高血压患者会出现头痛(特别是头部后部和早晨),以及头晕,眩晕,耳鸣(嗡嗡声或嘶嘶声),视力改变或昏厥发作。然而,这些症状可能与相关的焦虑有关,而不是高血压本身。

在体格检查中,高血压可能与眼底镜检查中视神经眼的变化有关。高血压性视网膜病变典型变化的严重程度从I到IV分级; I级和II级可能难以区分。视网膜病变的严重程度与高血压的持续时间或严重程度大致相关。

继发性高血压
主要文章:继发性高血压
具有某些特定额外体征和症状的高血压可能表明继发性高血压,即由于可识别原因引起的高血压。例如,库欣综合征经常导致躯干肥胖,葡萄糖耐受不良,月亮面,颈部/肩部后面的一团脂肪(称为水牛驼峰)和紫色腹部妊娠纹。甲状腺功能亢进经常导致体重减轻,食欲增加,心率加快,眼球突出和震颤。肾动脉狭窄(RAS)可能与中线左侧或右侧(单侧RAS)或两个位置(双侧RAS)的局部腹部瘀伤有关。主动脉缩窄经常导致下肢相对于手臂的血压降低,或者股动脉脉搏延迟或缺失。嗜铬细胞瘤可引起高血压突然(“阵发性”)发作,并伴有头痛,心悸,面色苍白和出汗过多。

高血压危象
主要文章:高血压危象
严重升高的血压(等于或大于收缩压180或舒张压110)被称为高血压危象。根据最终器官损伤的存在或不存在,高血压危象分为高血压急症或高血压急症。

在高血压急迫期,没有证据表明血压升高导致终末器官损伤。在这些情况下,口服药物用于在24至48小时内逐渐降低血压。

在高血压急症中,有证据表明一个或多个器官受到直接损害。 受影响最严重的器官包括脑,肾,心脏和肺,产生的症状可能包括混乱,嗜睡,胸痛和呼吸困难。在高血压急症中,必须更快地降低血压以阻止持续的器官损伤,然而,这种方法缺乏随机对照试验证据。

怀孕
主要文章:妊娠期高血压和先兆子痫
大约8-10%的妊娠发生高血压。相隔6小时,大于140/90 mm Hg的两次血压测量可以诊断出妊娠期高血压。妊娠期高血压可分为既往高血压,妊娠期高血压或先兆子痫。

先兆子痫是妊娠后半期的一种严重疾病,其特征是血压升高和尿液中存在蛋白质。它发生在大约5%的怀孕中,并且占全球所有孕产妇死亡的大约16%。先兆子痫还会使出生时婴儿死亡的风险增加一倍。通常在先兆子痫中没有症状,并且通过常规筛查检测到。当先兆子痫症状出现时,最常见的是头痛,视觉障碍(通常是“闪烁的灯光”),呕吐,胃部疼痛和肿胀。先兆子痫偶尔会发展为一种危及生命的疾病,称为子痫,这是一种高血压急症,并有几种严重的并发症,包括视力减退,脑肿胀,癫痫发作,肾功能衰竭,肺水肿和弥散性血管内凝血(血液凝固障碍) 。

相比之下,妊娠期高血压被定义为妊娠期新发高血压,而尿液中没有蛋白质。

孩子
未能茁壮成长,癫痫发作,烦躁,缺乏活力和呼吸困难可能与新生儿和幼儿的高血压有关。在年龄较大的婴儿和儿童中,高血压可引起头痛,无法解释的烦躁,疲劳,茁壮成长,视力模糊,流鼻血和面瘫。

原因
原发性高血压
主要文章:原发性高血压
高血压是由基因和环境因素的复杂相互作用引起的。已经鉴定了许多对血压影响小的常见遗传变异以及一些对血压有很大影响的罕见遗传变异。此外,全基因组关联研究(GWAS)已经确定了35个与血压相关的基因位点;新发现了12个影响血压的基因位点。已鉴定的每个新遗传基因座的Sentinel SNP显示与多个附近CpG位点的DNA甲基化相关。这些前哨SNP位于与血管平滑肌和肾功能相关的基因内。 DNA甲基化可能以某种方式影响将常见的遗传变异与多种表型联系起来,即使这些关联的机制尚未被理解。在这项研究中对35名前哨SNP(已知和新的)进行的单一变异试验表明,单独或聚合的遗传变异有助于与高血压相关的临床表型的风险。

血压随着年龄的增长而升高,并且在以后的生活中变得高血压的风险相当大。一些环境因素会影响血压。高盐摄入会增加盐敏感个体的血压;缺乏运动,肥胖和抑郁可以在个别病例中发挥作用。其他因素如咖啡因摄入和维生素D缺乏的可能作用尚不清楚。胰岛素抵抗在肥胖症中很常见,并且是X综合征(或代谢综合征)的一个组成部分,也被认为是导致高血压的原因。一篇综述表明糖可能在高血压中发挥重要作用,盐只是一个无辜的旁观者。

早产儿的事件,如低出生体重,母亲吸烟和缺乏母乳喂养可能是成人原发性高血压的危险因素,尽管将这些暴露与成人高血压联系起来的机制仍不清楚。与血压正常的人相比,未经治疗的高血压人群中发现高血尿素的比率增加,但不确定前者是否起因果作用或是否与肾功能不良有关。冬季的平均血压可能高于夏季。牙周病也与高血压有关。

继发性高血压
主要文章:继发性高血压
继发性高血压是由可识别的原因引起的。肾病是高血压最常见的继发病因。高血压也可由内分泌疾病引起,如库欣综合征,甲亢,甲状腺功能减退症,肢端肥大症,康恩综合征或醛固酮增多症,肾动脉狭窄(动脉粥样硬化或纤维肌肉发育不良),甲状旁腺功能亢进和嗜铬细胞瘤 。继发性高血压的其他原因包括肥胖,睡眠呼吸暂停,怀孕,主动脉缩窄,过量进食甘草,过量饮酒,以及某些处方药,草药和非法药物如可卡因和甲基苯丙胺。 ]通过饮用水暴露砷与血压升高有关 。

2018年的一项审查发现,任何酒精都会增加男性的血压,而超过一两杯饮料会增加女性患病的风险。

病理生理学
主要文章:高血压的病理生理学


平均动脉压的决定因素


插图描绘了高血压的影响
在大多数确定原发性高血压的人中,增加的血流阻力(总外周阻力)导致高压,而心输出量仍然正常。有证据表明,一些患有高血压前期或“临界高血压”的年轻人心输出量高,心率加快,外周阻力正常,称为过度活动性临界高血压。随着年龄的增加,这些人的心输出量下降,外周阻力随着年龄的增长而逐渐升高。这种模式是否是所有最终患高血压的人的典型特征是有争议的。既定高血压的外周阻力增加主要归因于小动脉和小动脉结构变窄,尽管毛细血管数量或密度的减少也可能有所贡献。

目前尚不清楚小动脉血管的血管收缩是否在高血压中发挥作用。高血压还与外周静脉顺应性降低有关,这可能会增加静脉回流,增加心脏前负荷,并最终导致舒张功能障碍。

脉搏压力(收缩压和舒张压之间的差异)经常在患有高血压的老年人中增加。这可能意味着收缩压异常高,但舒张压可能正常或低,称为单纯收缩期高血压。高血压或单纯收缩期高血压老年人的高脉压可通过动脉硬度增加来解释,动脉硬度通常伴随衰老,并可能因高血压而恶化。

已经提出了许多机制来解释高血压中外周阻力的增加。大多数证据表明肾脏盐和水处理的紊乱(特别是肾内肾素 - 血管紧张素系统的异常)或交感神经系统的异常。这些机制并不是相互排斥的,并且在大多数原发性高血压病例中,这两种机制都有可能在某种程也有人认为,内皮功能障碍和血管炎症也可能导致高血压患者的外周阻力和血管损伤增加 。白细胞介素17因其在增加高血压相关的其他几种免疫系统化学信号(如肿瘤坏死因子α,白细胞介素1,白细胞介素6和白细胞介素8)中的作用而引起了人们的兴趣。

摄入过量的钠和/或钾不足会导致过量的细胞内钠,这会使血管平滑肌收缩,限制血液流动,从而增加血压。

诊断

高血压的诊断基于持续高的静息血压。美国心脏协会建议至少在两次不同的医疗护理访问中至少进行三次静息测量。如果临床血压为140/90 mmHg或更高,英国国家健康和护理卓越研究所建议进行动态血压监测,以确认高血压的诊断。

为了准确诊断高血压,必须使用适当的血压测量技术。血压测量不当是常见的,并且可以将血压读数改变高达10 mmHg,这可能导致高血压的误诊和错误分类。正确的血压测量技术涉及几个步骤。适当的血压测量要求测量血压的人静静地坐下至少五分钟,然后在裸露的上臂上施加适当的血压袖带。该人应坐在背部支撑,双脚平放在地板上,双腿未交叉。测量血压的人应避免在此过程中说话或移动。被测量的手臂应该支撑在心脏水平的平坦表面上。血压测量应该在一个安静的房间进行,这样检查血压的医疗专业人员可以听到Korotkoff声音,同时用听诊器听肱动脉进行准确的血压测量。 在听Korotkoff声音的同时,血压袖带应缓慢放气(2-3 mmHg / s)。在测量人的血压之前应该清空膀胱,因为这会使血压升高15/10 mmHg。应获得间隔1-2分钟的多个血压读数(至少两个),以确保准确性。 12至24小时的动态血压监测是确认诊断的最准确方法。

例外的是血压读数非常高的患者,特别是当器官功能较差时。对高血压患者的初步评估应包括完整的病史和体格检查。随着24小时动态血压监测仪和家用血压计的可用性,不错误诊断白大衣高血压患者的重要性导致协议的变化。在英国,目前的最佳做法是通过门诊测量来跟踪单个升高的门诊读数,或者在7天的过程中不太理想地进行家庭血压监测。美国预防服务工作组还建议在医疗保健环境之外进行测量。

老年人的高血压或非压缩性动脉综合征也可能需要考虑。这种情况被认为是由于动脉钙化导致血压袖带异常高血压读数,而动脉血压测量正常。直立性高血压是指站立时血压升高的情况。

一旦确诊为高血压,医疗保健提供者应根据风险因素和其他症状(如果存在)尝试确定根本原因。继发性高血压在青春期前儿童中更常见,大多数病例由肾脏疾病引起。原发性或原发性高血压在青少年中更常见,并且有多种危险因素,包括肥胖和高血压家族史。还可以进行实验室检查以确定继发性高血压的可能原因,并确定高血压是否对心脏,眼睛和肾脏造成损害。通常进行糖尿病和高胆固醇水平的额外检查,因为这些病症是心脏病发展的其他风险因素,可能需要治疗。

测量血清肌酸酐以评估肾脏疾病的存在,肾脏疾病可能是高血压的原因或结果。单独使用血清肌酐可能会高估肾小球滤过率,最近的指南主张使用预测方程,例如肾脏疾病饮食改良(MDRD)公式来估计肾小球滤过率(eGFR)。 eGFR还可以提供肾功能的基线测量,可用于监测某些抗高血压药物对肾功能的副作用。另外,尿液样本的蛋白质测试被用作肾脏疾病的次要指标。进行心电图(EKG / ECG)测试以检查心脏处于高血压应变状态的证据。它还可以显示心肌是否增厚(左心室肥大)或心脏是否经历过先前的轻微干扰,例如无声心脏病发作。还可以进行胸部X光或超声心动图以寻找心脏扩大或心脏受损的迹象。

成人
成人分类(不同类别的收缩压和舒张压患者被分配到更高的类别。)

在18岁或18岁以上的人群中,高血压被定义为收缩压或舒张压测量值始终高于可接受的正常值(根据指南,这高于129或139 mmHg收缩压,89 mmHg舒张压)。 [ 7]如果测量来自24小时门诊或家庭监测,则使用其他阈值(135 mmHg收缩压或85 mmHg舒张压)。最近的国际高血压指南也创建了低于高血压范围的类别,表明在正常范围内血压升高的连续风险。 2003年发表的高血压预防,检测,评估和治疗联合国家委员会(JNC7)第七次报告使用术语高血压前期血压在120-139 mmHg收缩压或80-89 mmHg舒张压范围内,而欧洲高血压学会指南(2007)和英国高血压学会(BHS)IV(2004)使用最佳,正常和高正常类别细分压力低于140 mmHg收缩压和90 mmHg舒张压。高血压也被分类:JNC7区分高血压I期,高血压II期和单纯收缩期高血压。单纯收缩期高血压是指收缩压升高,舒张压正常,在老年人中很常见。 ESH-ESC指南(2007)和BHS IV(2004)另外定义了收缩压超过179 mmHg或舒张压超过109 mmHg的人的第三阶段(III期高血压)。如果药物不能将血压降低到正常水平,高血压就被归类为“抵抗”。 2017年11月,美国心脏协会和美国心脏病学会发布了一项联合指南,更新了JNC7报告的建议。

孩子
高血压发生在约0.2%至3%的新生儿中;然而,健康新生儿并不常规测量血压。高血压在高危新生儿中更为常见。在决定新生儿的血压是否正常时,需要考虑各种因素,如孕龄,孕后年龄和出生体重。

高血压定义为多次就诊时血压升高影响1%至5%的儿童和青少年,并且与长期健康不良风险有关。儿童期血压随着年龄的增长而升高,在儿童中,高血压被定义为三次或更多次的平均收缩压或舒张压,其等于或高于适合于儿童的性别,年龄和身高的第95百分位数。在将儿童描述为患有高血压之前,必须在反复就诊时确认高血压。儿童的高血压前期定义为平均收缩压或舒张压大于或等于第90百分位数,但小于第95百分位数。在青少年中,有人提出使用与成人相同的标准诊断和分类高血压和高血压前期。

对3岁以上儿童的高血压常规筛查的价值进行了辩论。 2004年,国家高血压教育计划建议3岁及以上的儿童在每次医疗护理访问时至少进行一次血压测量,国家心肺血液研究所和美国儿科学会进行类似测试建议。然而,美国家庭医生学会支持美国预防服务工作组的观点,即现有证据不足以确定没有症状的儿童和青少年高血压筛查的益处和危害的平衡。[ 94]

预防
高血压的大部分疾病负担都是由未被标记为高血压的人所经历的。因此,需要人口策略来减少高血压的后果并减少对抗高血压药物的需求。在开始服用药物之前,建议改变生活方式以降低血压。 2004年英国高血压学会指南提出的生活方式改变与美国国家高血压教育计划2002年概述的生活方式改变一致,用于高血压的一级预防:

保持成人正常体重(例如体重指数20-25 kg / m2)
减少饮食钠摄入量<100 mmol / day(氯化钠<6 g或每天<2.4 g钠)
定期进行有氧运动,如快走(每天≥30分钟,一周中大部分时间)
限制男性饮酒量不超过3个单位/天,女性不超过2个单位/天
食用富含水果和蔬菜的饮食(例如每天至少五份);
有效的生活方式改变可以像单独的抗高血压药物一样降低血压。两种或两种以上生活方式改变的组合可以取得更好的效果。有大量证据表明,减少饮食中的盐摄入会降低血压,但这是否会导致死亡率和心血管疾病的降低仍然不确定。估计钠摄入量≥6g/天且<3g /天都与高死亡风险或主要心血管疾病有关,但高钠摄入与不良后果之间的关联仅见于高血压患者。因此,在没有随机对照试验结果的情况下,减少饮食盐摄入量低于3克/天的智慧受到了质疑。

管理
主要文章:高血压管理
根据2003年发表的一篇综述,血压降低5 mmHg可使卒中风险降低34%,缺血性心脏病降低21%,降低痴呆,心力衰竭和心血管疾病死亡的可能性。

目标血压
另见:国际血压指南的比较
各个专家组制定了关于当一个人接受高血压治疗时血压目标应该有多低的准则。这些群体建议一般人群的目标低于140-160 / 90-100 mmHg。 Cochrane评价为糖尿病患者和既往心血管疾病患者等亚组推荐类似的目标。

许多专家组建议对60岁至80岁之间的人群稍微提高150/90 mmHg的目标。 JNC-8和美国内科医师学会建议60岁以上的人使用150/90 mmHg的目标, 但这些组中的一些专家不同意这一建议。一些专家组还建议糖尿病患者或尿液中蛋白质丢失的慢性肾脏疾病的目标略低,但其他人建议的目标与普通人群相同 。关于什么是最佳目标以及目标是否应该对高风险个体有所不同的问题尚未得到解决,尽管一些专家提出的血压降低比某些指南所倡导的更为强烈。

改变生活方式
高血压的第一线治疗方法是改变生活方式,包括饮食改变,体育锻炼和减肥。尽管这些都已在科学建议中被推荐,但Cochrane系统评价未发现体重减轻饮食对高血压患者死亡,长期并发症或不良事件的影响的证据。检讨确实发现血压下降。它们的潜在有效性类似于并且有时超过单一药物。如果高血压足以证明立即使用药物是合理的,那么仍然建议改变生活方式与药物一起使用。

显示降低血压的膳食变化包括低钠饮食, DASH饮食,素食饮食,和绿茶消费。 [ 121]

增加膳食钾对降低高血压风险具有潜在的益处。 2015年膳食指南咨询委员会(DGAC)指出,钾是美国消费不足的短缺营养素之一。

显示降低血压的体育锻炼方案包括等长阻力运动,有氧运动,阻力运动和装置引导呼吸。

减压技术,如生物反馈或超验冥想,可以被视为减少高血压的其他治疗的附加物,但没有证据可以自行预防心血管疾病。 自我监测和预约提醒可能会支持使用其他策略来改善血压控制,但需要进一步评估。

药物
几类药物,统称为抗高血压药物,可用于治疗高血压。

高血压的一线药物包括噻嗪类利尿剂,钙通道阻滞剂,血管紧张素转换酶抑制剂(ACE抑制剂)和血管紧张素受体阻滞剂(ARBs)。这些药物可单独使用或组合使用(不建议将ACE抑制剂和ARB联合使用);后一种选择可能有助于最大限度地减少反调节机制,使血压值恢复到治疗前的水平。 大多数人需要不止一种药物来控制高血压。当未达到目标水平时,应采用分步护理方法实施血压控制药物。

以前β受体阻滞剂如阿替洛尔被认为在用作高血压的一线疗法时具有相似的有益效果。然而,包括13项试验在内的Cochrane评价发现β受体阻滞剂的效果不如其他抗高血压药物在预防心血管疾病方面的作用。

抗性高血压
抗性高血压被定义为高血压仍然高于目标水平,尽管三种或更多种抗高血压药同时使用不同的作用机制。 未服用处方药物是导致耐药性高血压的重要原因。 抗性高血压也可能由自主神经系统的长期高活动引起,这种效应被称为“神经源性高血压”。 在这种情况下,正在研究刺激压力反射的电疗法作为降低人体血压的一种选择。

流行病学


2014年成年男子高血压患病率图。

2004年每10万居民患高血压性心脏病的残疾调整生命年。


成人
截至2014年,全球约有10亿成年人或约22%的人患有高血压。在男性中,在社会经济地位较低的人群中略高一些,随着年龄的增长而变得更为常见。这在高收入,中等收入和低收入国家很常见。 2004年,非洲的高血压发病率最高(两性均为30%),美洲最低(两性均为18%)。印度农村地区的费率也明显不同,波兰的比率低至3.4%(男性)和6.8%(女性),波兰的比例高达68.9%(男性)和72.5%(女性)。 2016年非洲的税率约为45%。

在欧洲,截​​至2013年,约有30-45%的人患有高血压。据估计,1995年美国有4300万人(占人口的24%)患有高血压或服用抗高血压药物。到2004年,这个数字已经增加到29% ,到2017年将增加到32%(7600万美国成年人)。 2017年,随着高血压定义的变化,美国有46%的人受到影响。美国的非洲裔美国人成年人中高血压发病率最高,为44%。它在菲律宾裔美国人中更常见,在美国白人和墨西哥裔美国人中也不常见。 高血压发病率的差异是多因素的并且正在研究中。

孩子
在过去20年中,美国儿童和青少年的高血压发病率有所增加。儿童期高血压,特别是青春期前的高血压,通常比成人高血压继发于潜在的疾病。肾病是儿童和青少年中高血压最常见的继发原因。然而,原发性或原发性高血压占大多数病例。

成果
主要文章:高血压的并发症


图解说明了持续性高血压的主要并发症
高血压是全球过早死亡的最重要的可预防风险因素。 它增加了缺血性心脏病,中风,外周血管疾病,和其他心血管疾病的风险,包括心力衰竭,主动脉瘤,弥漫性动脉粥样硬化,慢性肾病,心房颤动和肺栓塞。 高血压也是认知障碍和痴呆的危险因素。 其他并发症包括高血压性视网膜病变和高血压性肾病。

历史
主要文章:高血压病史


来自Harvey's Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus的静脉图像
测量
对心血管系统的现代认识始于医生William Harvey(1578-1657)的工作,他在他的书“De motu cordis”中描述了血液的循环。英国牧师斯蒂芬·黑尔斯于1733年首次公布了血压测量结果。 然而,作为临床实体的高血压与Scipione Riva-Rocci于1896年发明的基于袖带的血压计有关。这样可以轻松测量临床的收缩压。 1905年,Nikolai Korotkoff通过描述当血压计袖带收缩时用听诊器将动脉固定时听到的Korotkoff声音改进了该技术。这允许测量收缩压和舒张压。

鉴定
类似于高血压危象患者症状的症状在“充实性疾病”一章中的中世纪波斯医学文献中进行了讨论。症状包括头痛,头部沉重,运动迟缓,全身发红,身体温暖触感,突出,膨胀和紧张的血管,脉搏充盈,皮肤扩张,尿色,致密,食欲不振,视力低下,思维障碍,打哈欠,嗜睡,血管破裂和出血性中风。假定充盈性疾病是由于血管内血液过量引起的。

高血压作为一种疾病的描述来自于1808年的托马斯·杨,特别是1836年的理查德·布莱特。 Frederick Akbar Mahomed(1849-1884)首次报道了没有肾病证据的人血压升高的报告。

治疗
历史上,对所谓“硬脉冲疾病”的治疗包括通过放血或使用水蛭来减少血液量。这是由中国黄帝,科尼利厄斯塞尔苏斯,盖伦和希波克拉底所倡导的。治疗硬脉疾病的治疗方法包括生活方式的改变(远离愤怒和性交)和患者的饮食计划(避免食用葡萄酒,肉和糕点,减少餐中的食物量,维持低能量饮食和菠菜和醋的饮食习惯)。

在19世纪和20世纪,在高血压的有效药物治疗成为可能之前,使用了三种治疗方式,都有许多副作用:严格的钠限制(例如水稻饮食),交感神经切除术(部分手术切除)交感神经系统)和热原疗法(注射引起发烧的物质,间接降低血压)。

第一种高血压化学品,硫氰酸钠,于1900年使用,但有许多副作用,并且不受欢迎。在第二次世界大战后开发了几种其他药剂,其中最受欢迎且最合理有效的是四甲基氯化铵,六甲基肼,肼屈嗪和利血平(来自药用植物Rauwolfia serpentina)。这些都没有得到很好的容忍。 通过发现第一批耐受良好的口服药物,取得了重大突破。第一种是氯噻嗪,第一种噻嗪类利尿剂,由抗生素磺胺发展而来,于1958年上市。 随后,β受体阻滞剂,钙通道阻滞剂,血管紧张素转换酶(ACE)抑制剂,血管紧张素受体阻滞剂和肾素抑制剂被开发为抗高血压药物。

社会与文化
意识


图表显示NHANES的四项研究之间的高血压意识,治疗和控制的普遍性
世界卫生组织已将高血压或高血压确定为心血管死亡的主要原因。世界高血压联盟(WHL)是一个由85个国家高血压学会和联盟组成的伞式组织,它认识到全世界超过50%的高血压人群并不知道自己的病情。为解决这一问题,世界高血压联盟于2005年发起了一项关于高血压的全球宣传运动,并将每年的5月17日作为世界高血压日(WHD)。在过去三年中,越来越多的国家社会参与了WHD,并在其活动中不断创新,以向公众传播信息。 2007年,WHL的47个成员国创纪录地参与其中。在WHD这一周,所有这些国家 - 与当地政府,专业协会,非政府组织和私营企业合作 - 通过多家媒体和公众集会在公众中宣传高血压意识。通过使用互联网和电视等大众媒体,这一消息传达了超过2.5亿人。随着这种势头逐年增加,世界高血压联盟有信心几乎所有估计有15亿人受到血压升高的影响。

经济学
高血压是最常见的慢性疾病问题,促使美国初级卫生保健提供者访问。美国心脏协会估计2010年高血压的直接和间接成本为766亿美元。在美国,80%的高血压患者了解自己的病情,71%的患者服用抗高血压药物,但只有48%的人意识到患有高血压的患者能够充分控制它。由于诊断,治疗或控制高血压的不足,可能会妨碍对高血压的充分管理。医疗保健提供者在实现血压控制方面面临许多障碍,包括抵制服用多种药物达到血压目标。人们还面临着坚持医学时间表和改变生活方式的挑战。尽管如此,实现血压目标是可能的,最重要的是,降低血压可以显着降低因心脏病和中风导致死亡的风险,其他衰弱状况的发展以及与先进医疗相关的成本。

研究
对几项研究的2015年回顾发现,使用补充剂(每天超过1,000 IU)恢复血液维生素D水平会降低高血压患者维生素D缺乏时的血压。结果还表明长期低维生素D水平与高血压发生率的相关性。维生素D缺乏的正常血压患者补充维生素D超过18个月并未显着影响血压。

有初步证据表明钙摄入量增加可能有助于预防高血压。但是,需要更多的研究来评估最佳剂量和可能的副作用。

其他动物

猫的高血压表明收缩压大于150 mm Hg,氨氯地平是常用的一线治疗方法。

小狗
正常血压在品种之间可能存在显着差异,但如果收缩压高于160 mm Hg,则通常会诊断出犬的高血压,特别是如果这与目标器官损害有关。肾素 - 血管紧张素系统和钙通道阻滞剂的抑制剂通常用于治疗犬的高血压,尽管其他药物可能适用于引起高血压的特定病症。

视频: ↓ 什么是高血压?
https://cache.tv.qq.com/qqplayerout.swf?vid=p13247wt4co

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