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100 Questions in Cardiology - Part 2

Mục đích chính của áp lực điều trị máu (BP) là để giảm nguy cơ của đột quỵ và CHD. Giả sử các nguyên nhân thứ hai của cao huyết áp đã được loại trừ, quyết định để điều trị một mức độ cụ thể của BP là dựa trên một đánh giá về nguy cơ của đột quỵ, bệnh động mạch vành tim (CHD) và bệnh thận tăng huyết áp ở bệnh nhân. | 6 100 Questions in Cardiology Endocrine investigations. 24 hour urinary cortisol Cushing s syndrome 24 hour noradrenaline adrenaline dopamine catecholamine-secreting tumours and plasma renin and aldosterone Conn s syndrome may all be warranted. 100 Questions in Cardiology 7 4 What blood pressure should I treat and what should I aim fOr when treating a 45 year old a 60 year old a 75 year old or an 85 year old Aroon Hingorani Who to treat The primary aim of blood pressure BP treatment is to reduce the risk of stroke and CHD. Assuming secondary causes of hypertension have been excluded the decision to treat a particular level of BP is based on an assessment of the risk of stroke coronary heart disease CHD and hypertensive renal disease in the individual patient. All patients with evidence of target organ damage left ventricular hypertrophy retinopathy or hypertensive nephropathy are considered to be at high risk and should receive treatment whatever the level of BP. Similarly all patients who have previously suffered a stroke or CHD should have their BP lowered if it is above 140 90mmHg. Difficulties arise in those without end-organ damage or a previous cardiovascular event. Guidelines in the UK have advocated antihypertensive treatment for sustained BP levels above 160 100mmHg since in these individuals the risks of stroke and renal disease are unacceptably high. Absolute risk of stroke or CHD depends however not only on BP but also on the combination of other risk factors age gender total cholesterol HDL-cholesterol smoking diabetes and left ventricular hypertrophy . Their synergistic interaction in any individual makes universal application of BP thresholds perhaps inappropriate and some individuals with BP 140 90mmHg will benefit from treatment. Recent guidelines on treatment have also advocated a global assessment of risk rather than focusing on individual risk factors. The risk of stroke or CHD in an individual can be calculated using tables1 or computer .