心脑血管疾病营养治疗原发性高血压
一、概述
Hypertension is a common public health problem in developed countries. Untreated hypertension leads to many degenerative diseases, including congestive heart failure, end-stage renal disease, and peripheral vascular disease. It is often called a “silent killer” because people with hypertension can be asymptomatic for years and then have a fatal stroke of heart attack. Although no cure is available, prevention and management decrease cardiovascular disease mortality over the last two decades has been attributed to the increased detection and control of hypertension. The emphasis on lifestyle modifications has given diet a prominent role for both the primary prevention and management of hypertension. Of those with high blood pressure, 90% to 95% have essential or primary hypertension, for which the cause cannot be determined. Most likely there are many causes, including renal dysfunction. In the remaining 5%, hypertension arises as the result of another disease, usually endocrine, and thus is referred to as secondary hypertension. Depending on the extent of the underlying disease, secondary hypertension can be cured.
(一)定义与分类
1999年世界卫生组织/国际高血压联盟指南(World Health
Organization - International Society of Hypertension guidelines, WHO/ISH guidelines)中的高血压定义为:未服抗高血压药的情况下,收缩压≥140mmHg和(或)舒张压≥90mmHg。血压水平与心血管疾病危险呈正相关。WHO/ISH指南专家委员会认为,以往以“期”分类有病程进展阶段的含义,而目前仅按血压水平分类,不反映病程,故改用“级”。所以目前的1、2、3级(与前一版WHO/ISH指南中的轻、中、重相对应)取代美国国家委员会指南中的1、2、3期,又将临界高血压列为1级的亚组(收缩压为140~149mmHg,舒张压为90~94mmHg),还将收缩压140~149mmHg、舒张压<90mmHg列为临界性单纯性收缩期高血压。除以上表述外,WHO/ISH指南还强调,患者血压增高,决定应否给予降压治疗时,不仅要根据血压水平,还要根据其他危险因素的数量和程度,即“轻度”高血压只是与重度血压升高相对而言,并不意味预后必然良好。目前中国高血压防治指南基本上采用《1999 WHO/ISH高血压治疗指南》的分类标准。 表14-1 血压水平的定义和分类 类 别 收缩压(mmHg) 舒张压(mmHg)
理想血压 正常血压 正常高值 高血压 1级(轻度) 2级(中度) 3级(重度) 单纯收缩期高血压 <120 <130 120~139 140~159 160~179 ≥180 ≥140 <80 <80 80~89 90~99 100~109 ≥110 <90 引自:陆再英、钟南山主编,内科学(第7版),2008年。 (二)流行病学
我国1991年对15岁以上94万人群进行了抽样调查。结果显示,与10年前相比,高血压的患病率增加25%。调查还显示,高血压的知晓率、治疗率、控制率均很低,尤其是控制率仅达2.9%。2001年我国脑血管疾病居城市居民死亡原因第二位,在农村居首位。据世界卫生组织预测,至2020年,非传染性疾病将占我国死亡原因的79%,其中心血管疾病将占首位。高血压是最常见的心血管疾病,是全球范围内的重大公共卫生问题,不仅患病率高、死亡率高,而且可引起心、脑、肾并发症,是冠心病、脑卒中和早死的主要危险因素。
疾病营养治疗指导方案:心脑血管疾病营养治疗原发性高血压
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