54
專家論壇
ٙࠥᏀᖹ
ي
Ꮠ༈݊
ڗ
ࣖٙfஷ੬݊ίϘો
א
ɪʹɓ
ϣ͜ɓ၇
א
၇
ڗ
ࣖٙࠥᏀᖹf
Ш݊dίᑗґɪ੬ึ༾Ցʔˇઃ٫ίϘોɓϣ͜
ɓ၇
א
ε၇
ڗ
ࣖࠥᏀᖹ
ܝ
dՉցග
א
ોٙАᏀʥ
್༰৷f್݅ٙ݊͜
ڗ
ࣖࠥᏀᖹ
މ
ОৎʔՑ
ڗ
ࣖ
Ъ͜ճkவ݊Ϊ
މ
ͦ
ۃ
ٙ
ݔ
Ԭ¨
ڗ
ࣖ©ࠥᏀᖹ֠ʔ
ঐॆ͍ί
24
ʃࣛlzᖢ࿒ࠥᏀdֻֻί௰
ܝ
ٙ
4~6
ʃࣛ͟Аᖹዢ
ܓ
ٙနɨࠥϾኬ
ߧ
А
Ꮐʺ৷f
࿁வᗳઃ٫Ꮠ࣬ኽ
24
ʃࣛਗ࿒АᏀ
ٙഐ
؈
ਗ਼ࠥᏀᖹ׳ίАᏀᜑʺ৷
ۃ
4~6
ʃࣛ͜dɰఱ݊ႭdࠥᏀᖹ׳
ίͣ˂ᒔ݊׳ίցග̀͜ΪɛϾ
ମdʔ̀
إ
ɓࣸfցගʔঐࠥ͜Ꮐ
ᖹٙෂ୕ᝈׂ͍ίҷᜊʕf
頑固性高血壓的幾個問題
ה
ፗཬո৷АᏀܸ݊Νࣛ͜ɧ
၇˸ɪٙࠥᏀᖹ
৷ܝ
АᏀʥ͊ঐՑ
છՓfՉ೯͛ଟ
މߒ
20%~30%
f߰Ύ
ʱdബੵᏀᗭ༺ᅺ٫Ц
10%
dШϗ
ᐵᏀʔ༺ᅺ٫
ۍ
Ц
51%
dˈՉ݊ϼϋd
̸܃٭ɽٙઃ٫f
75
๋˸ɪٙϼϋ
ઃ٫
3/4
ʔঐတจήછՓϗᐵᏀdவ
ၾਗএʷᗫfʕϋɛബੵᏀᗭ˸
༺
ᅺٙႰΪʕ
1/3
݊ၾ٭
ߛ
Ϟᗫf
ཬո৷АᏀઃ٫ʕ
10%
މ
ᘱ೯৷АᏀdуϞ
ݔ
ߧ၇
АᏀʺ৷ٙਿᓾषfՉʕ௰੬Ԉٙ݊ࡡ೯⺂
ո●ᄣεसࡡ⺂f͟
30%
ٙࡡ⺂ઃ٫Аཏ͍
੬d༰εٙࡡ⺂ઃ٫ٙЭАཏ
ڌ
ତίशषٙૉಂd
ΪϤd࿁Ϙಂᆽൢ੭Ըɓ֛ѢᗭfШɓ͇ᆽൢ
ܝ
ط
ᐕ੬̙ԴषઋՑછՓ
طא
ᓹf
ᘱ೯৷АᏀઃ٫ʕ̤ɓ၇༰੬Ԉٙशष
݊ွेխіᅲ৾ၝΥּf߰ΥԻϞ٭
ߛ
ۆ
षઋһᘌࠠfνঐίࠥᏀᖹ
ي
Ꮠٙ͜Ν
ࣛৣΥમ͜ցග͍Ꮐஷंٙխіዚ
ط
ᐕdɽ
ε̙ԴАᏀՑϞࣖછՓf
ࡡ೯ཬո৷АᏀઃ٫ʕ٭
ߛ
d
ϼϋdைৢdෘഃႰΪʕৰϼϋ
ɓධೌ
ج
ҷᜊ̮dጐҷഛ͛
ݺ
˙ό̘ৰɪ
ࠑ
ႰΪdঐϞл
АᏀٙ༺ᅺf
ڐ
ϋԸdϞɓ၇อٙ
ط
ᐕ˙
ج
dу͜ኬ၍࢛᎖ऊፄ
ج
̘
ഥਗএʹชग़dࠥᏀٙᐕ
ࣖ
ܘ
λd̙Դઃ٫ίவ၇ʧɝ
ط
ᐕ
ܝ
ಯˇᏐ͜
אޟ
ʔࠥ͜Ꮐ
ᖹfεᅰӺ٫Ⴉ
މ
வɓอٙ
ط
ᐕ
ߕ౻ۃج
λflzɰʊϞɛ͜
Ը
ط
ᐕཬո৷АᏀdᐕࣖఘ၈တจf
New Insights into a Classical Problem
When taking blood pressure (BP), rest 5 min first; the upper arm should be at the level of the heart. Taking the findings of the UK
Prospective Diabetes Study (UKPDS), when diabetes and hypertension co-exist, BP has priority over sugar control: <130/80.
For most elderly, aim at a BP of 150 systolic or lower. The risks of cardiovascular events are related to the BP control. However, there
is a “flat-spot” below which the incidence of cardiovascular events would not drop but increases. The International Verapamil SR-
Trandolapril (INVEST) Study, involving 22,576 hypertensive coronary artery disease patients found a trough of the lowest cardiac
events at 70-80 diastolic. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study found diabetics at high risk for
cardiovascular events, targeting a BP <120 systolic (vs <140), did not reduce fatal and nonfatal major cardiovascular events. Our
Guidelines are <150/90 for the elderly; for those with diabetes, <130/80. Masked hypertension is high BP at night; normal in the day:
mostly due to hectic life styles or overwork. Intractable BP may be secondary, e.g., to sleep apnea. Optimize your lifestyle!
