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哮喘患者的高血压治疗
Treatment of Hypertension in Patients with Asthma


Sandra C. Christiansen ... 心脑血管疾病 呼吸系统疾病 • 2019.09.12
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• 莫米松或噻托溴胺治疗痰嗜酸性粒细胞低水平的轻度哮喘 • 强化降压与标准降压比较的随机试验

哮喘和高血压是常见慢性病,可使患者患病、死亡并产生经济方面的影响。据估计,全世界有3亿人患哮喘,预计到2025年将增加到4亿。每年约有25万人死于哮喘,而其中许多被认为是可以避免的1。美国有超过8%的成人患哮喘,其中女性、少数族裔和经济状况不佳的人群所占比例较高。2013年与哮喘相关的医疗支出估计为800亿美元2。高血压合并哮喘造成额外的健康负担。在全球范围内,高血压是心血管疾病和死亡的最常见的可缓解的危险因素。据估计,全球有8.74亿成人的收缩压高于140 mmHg 3,4,而且和哮喘一样,高血压的患病率、相关费用、发病率和死亡率都在增加5。在2015年全球的可预防死亡中,收缩压升高是主要促发原因6。美国有约1/3的成人患高血压7。由于现行高血压指南纳入了支持较低治疗阈值的新证据,因此我们认为患高血压的人数将增加,随之而来的费用也将增多3

哮喘患者比非哮喘患者更易患高血压,这与常规危险因素无关8。高血压诊断与哮喘加重相关9,并且肺功能下降与心血管死亡率增加相关10。考虑到肺功能受损和心血管功能受损之间的双向关系,对哮喘患者进行高血压治疗和控制的依据是令人信服的。虽然基本上未研究过血压控制对哮喘的影响,但当收缩压降至低于130 mmHg时,死于心血管疾病的风险会降低11-14。在本综述中,我们讨论了高血压与哮喘在机制方面的潜在关联、高血压和哮喘的相互影响,以及成人哮喘患者的高血压治疗方法。





作者信息

Sandra C. Christiansen, M.D., and Bruce L. Zuraw, M.D.
From the Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego (S.C.C., B.L.Z.), and the Medicine Service, San Diego Veterans Affairs Healthcare (B.L.Z.) — both in San Diego. Address reprint requests to Dr. Christiansen at 8899 University Ln., Suite 230, Mailcode #0976, San Diego CA 92122, or at scchristiansen@ucsd.edu.

 

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