2024年6月27日-30日，第十八届东方心脏病学会议（OCC）&世界心脏病学大会（WCC）在上海国际会议中心隆重召开。会议期间，高血压论坛作为大会的重点内容之一，展示了当前高血压诊疗领域的最新进展及治疗理念。其中，大会首日召开的高血压论坛的首场会议聚焦优化高血压检测及管理倡议，汇集国内外高血压领域著名专家，剖析当前高血压诊疗中检测及管理的重要意义。
首场会议特邀中国医科大学附属第一医院孙英贤教授、印度公共卫生基金会Prabhakaran Dorairaj教授作为联合主席，同时，孙英贤教授、兰州大学第二医院余静教授、英国帝国理工学院Neil Poulter教授以及泛美卫生组织Pedro Orduñez教授都围绕高血压监测及管理进行了精彩演讲。
From June 27-30, 2024, the 18th Oriental Congress of Cardiology (OCC) & World Congress of Cardiology (WCC) was grandly held at the Shanghai International Convention Center. During the conference, the Hypertension Forum, as one of the key contents of the congress, showcased the latest advances and treatment concepts in the field of hypertension diagnosis and treatment. On the first day of the conference, the opening session of the Hypertension Forum focused on initiatives to optimize hypertension detection and management, bringing together renowned experts in the field of hypertension from home and abroad to analyze the importance of detection and management in current hypertension diagnosis and treatment.
The opening session specially invited Professor Sun Yingxian from the First Affiliated Hospital of China Medical University and Professor Prabhakaran Dorairaj from the Public Health Foundation of India as co-chairs. Additionally, Professor Sun Yingxian, Professor Yu Jing from the Second Hospital of Lanzhou University, Professor Neil Poulter from Imperial College London, and Dr. Pedro Orduñez from the Pan American Health Organization all gave excellent presentations on hypertension monitoring and management.
开场致辞
众所周知，高血压是当前临床实践中的一项重要疾病负担，同时也是心血管疾病的重要负担之一，Prabhakaran Dorairaj教授在开场致辞中表示，虽然大家都已经认识到高血压对患者带来的危害，同时也了解如何控制高血压，但可惜的是，当前全球的高血压控制率仍不理想，因此本届会议中，高血压论坛的首场会议便是以高血压检测及管理为主题，希望今天的精彩讲座能为临床实践带来一些思考。
As is well known, hypertension is a significant disease burden in current clinical practice and also an important burden of cardiovascular disease. In his opening remarks, Professor Prabhakaran Dorairaj stated that although everyone has recognized the harm that hypertension brings to patients and understands how to control hypertension, unfortunately, the current global hypertension control rate is still not ideal. Therefore, in this conference, the first session of the Hypertension Forum focused on hypertension detection and management, hoping that today's excellent lectures would bring some thoughts to clinical practice.
女性一生中的高血压管理
女性患者一生中有着不同的生理阶段，因此在血压管理方面也需要格外关注。余静教授从女性患者一生血压变化轨迹、贯穿女性一生的高血压以及女性高血压的管理三个方面，全面剖析了女性患者进行高血压管理的要点内容。在月经初潮、妊娠期、绝经期以及老年期，女性血压变化都有着不同的特点，绝经后女性高血压患病率显著增加，绝经年龄与血压呈U型关系，在绝经年龄>50岁的人群中，绝经年龄对收缩压和舒张压的总影响显著。在60岁之前，高血压在女性中的发病率低于男性，60岁之后，这种情况就会逆转。此外，女性高血压会引起女性性功能障碍，兰州大学第二医院开展的一项研究显示，游离雄激素指数（FAI）和性激素结合球蛋白（SHBG）是绝经后高血压妇女LVH的影响因素，证实了性激素紊乱与绝经后高血压妇女LVH相关。在女性高血压患者的管理方面，后高血压妇女在开始激素替代治疗时应评估心血管不良风险。同时应该关注女性的血压，降低女性在不同生命阶段的高血压患病率。
Female patients have different physiological stages throughout their lives, so special attention needs to be paid to blood pressure management. Professor Yu Jing comprehensively analyzed the key points of hypertension management for female patients from three aspects: the trajectory of blood pressure changes throughout a woman's life, hypertension throughout a woman's life, and the management of hypertension in women. At menarche, during pregnancy, menopause, and old age, women's blood pressure changes have different characteristics. The prevalence of hypertension increases significantly after menopause, and the age of menopause has a U-shaped relationship with blood pressure. In people with menopause age >50 years, the total effect of menopause age on systolic and diastolic blood pressure is significant. Before the age of 60, the incidence of hypertension in women is lower than in men, but after 60, this situation reverses. In addition, hypertension in women can cause female sexual dysfunction. A study conducted by the Second Hospital of Lanzhou University showed that free androgen index (FAI) and sex hormone-binding globulin (SHBG) are influencing factors of left ventricular hypertrophy (LVH) in postmenopausal hypertensive women, confirming that sex hormone disorders are associated with LVH in postmenopausal hypertensive women. In terms of management of female hypertensive patients, postmenopausal women should assess cardiovascular adverse risks when starting hormone replacement therapy. At the same time, attention should be paid to women's blood pressure to reduce the prevalence of hypertension in women at different stages of life.
乡村高血压控制战略：
创新与实施
高血压控制率的提升一直是临床实践中面临的重要问题，孙英贤教授在讲课中系统阐述了高血压早期控制模式以及在多年发展中对高血压防控模式的探讨。上世纪60年代多次社区高血压患病率调查发现，社区高血压检出率、治愈率和控制率较低。随后，1984年JNC 3首次提出社区高血压管理提供长期咨询、随访和监测服务，是医院管理的补充。随后开展的E-BP、COBRA-BPS、HOPE4、CRHCP等相关研究，探讨了高血压防控的技术、策略和模型。其中，E-BP研究结果显示，家庭血压监测、网络沟通和药师护理可提高高血压控制率。我国开展的CRHCP研究结果显示，在资源匮乏的环境中，（专业）卫生保健提供者主导的高血压控制干预对降低心血管疾病、全因死亡率和痴呆是有效的。所有高血压成人降压目标（收缩压<130 mmHg和舒张压<80 mmHg）都是可行的，有利于降低心血管疾病的风险。这种有效、可采用和可持续的高血压控制策略应在其他资源匮乏人群中推广。
Improving hypertension control rates has always been an important issue in clinical practice. In his lecture, Professor Sun Yingxian systematically expounded on the early hypertension control model and the exploration of hypertension prevention and control models in many years of development. In the 1960s, multiple community hypertension prevalence surveys found that community hypertension detection rates, cure rates, and control rates were low. Subsequently, in 1984, JNC 3 first proposed that community hypertension management should provide long-term consultation, follow-up, and monitoring services as a supplement to hospital management. Subsequent studies such as E-BP, COBRA-BPS, HOPE4, and CRHCP explored the techniques, strategies, and models for hypertension prevention and control. Among them, the results of the E-BP study showed that home blood pressure monitoring, online communication, and pharmacist care can improve hypertension control rates. The results of the CRHCP study conducted in China showed that in resource-poor environments, (professional) healthcare provider-led hypertension control interventions are effective in reducing cardiovascular disease, all-cause mortality, and dementia. Blood pressure targets for all hypertensive adults (systolic blood pressure <130 mmHg and diastolic blood pressure <80 mmHg) are feasible and beneficial for reducing cardiovascular disease risk. This effective, adoptable, and sustainable hypertension control strategy should be promoted in other resource-poor populations.
世界各地的五月测量月倡议
五月血压测量月（May Measurement Month，MMM）”是由国际高血压学会（ISH）联合世界高血压联盟（WHL）及柳叶刀高血压委员会（LCH）共同发起的一项全球血压知晓活动，旨在进一步提高公众对血压测量重要性的认识。Neil Poulter教授表示，全球范围内的高血压知晓率和控制率都需要进一步提高，MMM通过在不同国家任命负责人进行协调，并对年龄≥18岁且希望测量血压的志愿者进行横断面调查，通过一系列的统计分析，当前借助MMM项目，让我们对高血压的控制与管理有了更深刻的认识。当前越来越多的证据鼓励政府改善BP筛查和管理政策，未来则需要进一步提供高质量的数据，在宣传教育方面可通过多种手段进一步加强普通患者的教育。此外，在高血压的诊疗方面也应为高血压的诊断和转诊管理建立一套完整的体系，如高血压中心建设等，从而更好的提高高血压的知晓率和控制率。
May Measurement Month (MMM) is a global blood pressure awareness campaign jointly initiated by the International Society of Hypertension (ISH), the World Hypertension League (WHL), and the Lancet Commission on Hypertension (LCH), aiming to further raise public awareness of the importance of blood pressure measurement. Professor Neil Poulter stated that hypertension awareness and control rates need to be further improved globally. MMM conducts cross-sectional surveys of volunteers aged ≥18 years who wish to measure their blood pressure by appointing coordinators in different countries. Through a series of statistical analyses, the MMM project has given us a deeper understanding of hypertension control and management. Currently, more and more evidence encourages governments to improve BP screening and management policies. In the future, it is necessary to provide higher quality data. In terms of publicity and education, various means can be used to further strengthen the education of ordinary patients. In addition, in terms of hypertension diagnosis and treatment, a complete system should be established for the diagnosis and referral management of hypertension, such as the construction of hypertension centers, to better improve hypertension awareness and control rates.
世卫组织全球心脏倡议
全球心脏倡议是由WHO与美国疾病控制中心发起的，以帮助卫生系统提高人群高血压控制和心血管疾病风险管理为目标的一项倡议，提供了一套高影响力、基于证据的干预措施，当这些干预措施一起使用时，将对改善全球心脏健康产生重大影响。当前已有27个国家实施该倡议所提供的临床路径，登记患者超过450万。Pedro Orduñez教授表示，当前全球范围内的心血管疾病负担都较为严重，高血压是其中最主要的风险因素，HEART为临床实践提供了一套完整的诊疗路径，包括血压测量、心血管风险管理以及最后的药物治疗，可进一步优化诊疗模式和护理模式。在智利，HEARTS模式被证明优于传统护理：治疗患者的控制效果更好（65% vs. 40%），血压降至140/90 mmHg以下所需时间更短（31 vs. 92天），治疗一年后的依从性和持久性更好（分别为71%和20%）。HEARTS倡议将是游戏规则的改变者，希望借助HEARTS倡议所带来的临床诊疗路径，进一步改善高血压患者诊疗现状，为广大患者带来更好的预后。
The Global HEARTS Initiative is an initiative launched by WHO and the US Centers for Disease Control and Prevention to help health systems improve population hypertension control and cardiovascular disease risk management. It provides a set of high-impact, evidence-based interventions that, when used together, will have a significant impact on improving global heart health. Currently, 27 countries have implemented the clinical pathways provided by this initiative, registering over 4.5 million patients. Dr. Pedro Orduñez stated that the current global burden of cardiovascular disease is severe, with hypertension being the main risk factor. HEARTS provides a complete diagnostic and treatment pathway for clinical practice, including blood pressure measurement, cardiovascular risk management, and finally drug treatment, which can further optimize diagnosis and treatment models and care models. In Chile, the HEARTS model has been proven to be superior to traditional care: better control of treated patients (65% vs. 40%), shorter time to reduce blood pressure below 140/90 mmHg (31 vs. 92 days), and better adherence and persistence after one year of treatment (71% and 20% respectively). The HEARTS initiative will be a game-changer, and it is hoped that the clinical diagnosis and treatment pathways brought by the HEARTS initiative will further improve the current situation of hypertension patient diagnosis and treatment, bringing better prognosis for the majority of patients.
在与会专家们的热烈讨论中，高血压论坛的首场会议逐渐落下了帷幕。高血压防控是一场持久战，不仅需要合适的治疗策略，同时需要加强对高血压患者的随访和管理，才能真正提升高血压控制率，降低心血管疾病负担，助力健康中国！
The first session of the Hypertension Forum gradually came to a close amidst heated discussions among the attending experts. Hypertension prevention and control is a long-term battle that requires not only appropriate treatment strategies but also strengthened follow-up and management of hypertensive patients to truly improve hypertension control rates, reduce cardiovascular disease burden, and contribute to a healthy China!
审核：曾春雨 孙英贤
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