In recent years, there has been a significant increase in the incidence of and mortality from coronary heart disease, which is an important risk factor for coronary heart disease, as well as a high cardiovascular risk and mortality rate for patients with hypertensive coronary heart disease, which can benefit from reasonable control of blood pressure.So how much blood pressure should people with hypertensive combined coronary heart disease have?01 Coronary heart disease combined with hypertensionWhy do you need pressure relief?Coronary heart disease is the primary combination of hypertension.2. Pressure relief treatment significantly reduces the risk of cardiovascular disease: for every 10 mm of reduction in constriction (SBP), the risk of major cardiovascular events is reduced by 20%, the risk of coronary heart disease is reduced by 17% and the risk among pawns by 27%.3. Reducing the risk of cardiovascular disease and death is the ultimate goal of pressure relief treatment.Domestic and international guidelines confirm the benefits of stress-relief therapy for cardiovascular vessels.02 Guidance recommendationsCoronary heart disease combined high blood pressure relief strategy.2017 American Cardiology Society (ACC)/AHA Guidelines for the Prevention, Detection, Assessment and Management of Hypertension for Adults:(1) A new definition of hypertension is proposed and the diagnostic standard is moved to 130/80 mmHg (replaces the previous high blood pressure standard of 140/90 mmHg).(2) Elimination of the category “precedent of hypertension”.(3) Pressure relief targets for hypertension combined with other diseases (pressure relief targets for hypertension combined coronary heart disease are 130/80 mmHg).ESC 2018/ESH Guidelines for the Treatment of Hightension:(1) High blood pressure diagnostic standard set at 140/90 mmHg (no change).(2) The standard of 24h dynamic blood pressure and the importance of self-measured blood pressure in the household were highlighted.(3) Recommended medication for persons with hypertensive combined coronary heart disease:Treatment steps and strategiesThe medicine.RemarksStep 1: Together1 ACEI or ARB+betareceptor retardant or CCS;2CCB+ urea or beta receptor retardant;3-beta receptor retardant + urea.Single medications are considered for low-risk level 1 hypertension patients or older persons over 80 years of age or persons who are weak.Step 2: Three combinationsThe three drugs mentioned above are combined.These high-risk persons (the presence of cardiovascular disease) can consider starting pressure relief treatment at a condensed thorium 130 mmHg.Step 3: Triple combination + other drugsIncurable hypertension, with propyl (25-50 mg/d) or other pressure relief: other urea, alpha receptor or beta receptor retardants.Referral to specialized centres for further treatment.3. Guidelines for the treatment of hypertension in China(1) Standard blood pressure < 120/80 mmHg and high blood pressure diagnostic standard < 140/90 mmHg.(2) Pressure relief targets for persons with hypertensive combined coronary heart disease: The pressure relief target level for hypertensive coronary heart disease is recommended at <140/90 mmHg as the pressure relief target for high blood pressure patients with combined coronary heart disease (1, A). Resilient can be reduced to <130/80 mmHg (Ia, B). It should be noted that DBP is not appropriate to fall below 60 mmHg (IIb, C). The blood pressure should not be too low for a patient of advanced age with a severely narrow coronary condition.
Coronary heart disease combined with pressure relief for hypertension patients
(1) Hypertensive combination of chronic stable CPR patients: β-receptor retardants for pre-heart infarction patients, ulcer infarction, left-cardial dysfunction, diabetes or chronic renal disease with an ACEI or ARB, and an aphrodisiac urea (I A).
(2) The use of β-receptor retardants, ACEI/ARB and thorium-like urea is also to be considered for persons with historical, left-heart infarction, diabetes or chronic kidney disease.
(3) If the beta receptor is inhibited or causes intolerant side effects, the non-dihydrohydrazine type CCB (dulphurium or Villapami) may be replaced, but not for persons with left cardiovascular dysfunction (II a B).
(4) If the heart pain or hypertension is not controlled, the long-activated dihydrohydrazine type CCB may be added to the basic programme of β-receptor retardants, ACEI and gill-like urea. For patients with symptoms of coronary heart disease and hypertension, care should be taken to combine the use of beta receptor retardants and non-dihydrohydrogenic CCB (dulfurium or Villapami) because it increases the risk of severe slow heart disorder and heart failure (II a B).
(5) Stabilized cardiac pain, with a blood pressure target of <140/90 mmHg(I A). However, lower blood pressure target values (<130/80 mmHg) (II b B) can be considered for some of the patients with coronary heart disease, pre-historic or short-term ischaemic haemorrhages and coronary heart diseases (capal arterytic disease, perivascular disease, abdominal aneurysm).
(6) There are no special taboos on the use of anti-sphygmophygmolytics or anticondensives by persons with high blood pressure, but those with severe uncontrolled hypertension are using anti-sphygmophyxia or anticondensatives, which require immediate decompression to reduce the risk of haemorrhagic pawns (II a C).
Stress relief recommended for persons with acute coronary syndrome combined hypertension
(1) In the case of acute coronary syndrome patients, there is no prohibition on the use of beta receptor retardants, and the initial decompressive treatment includes short-activated beta-1 selective receptor retardants (Metolore, Bosolore). The first dose of the drug (I A) is usually taken within 24h of the visit. In cases of severe hypertension or persistent ischaemic blood deficiency, an ivory beta receptor retardant (Aslore) can be considered (II a B). The use of beta-receptor retardants should be delayed until the condition is stable (I A) in cases of hemodynamically unstable patients or when heart failure occurs.
(2) Patients with a combination of acute coronary arterial syndrome with hypertension should consider the use of nitrate-type drugs to reduce blood pressure or to relieve persistent myocardial ischaemic or pulmonary silt (I C). Patients suspected of right heart infarction and patients with blood flow mechanics instability should avoid the use of nitrates. If appropriate, the first treatment of nitrite glycerine under the first sentence of treatment may be changed to a long-acting formulation.
(3) In the absence of left-heart dysfunction or heart failure, if the beta-receptor retardant is taboo or insufferable, a patient with a persistent ischaemic condition may be replaced by a non-dihydrohydrazine type CCB, such as thiramium or Villapami. If a simple beta receptor retardant is unable to control acoustic pain or hypertension, the use of ACEI can be justified with a long-acting dihydrohydrazine (II a B).
(4) AcEI(I A) or ARB(I A) should be added if the patient suffers from a pre-wall myocardial infarction and the blood pressure continues to rise, evidence of left-cardial dysfunction or heart failure, or diabetes. The choice of ACEI as a first-line decompression drug (II aA) is considered for the retention of left heart blood fractions and for low-critical coronary syndrome patients free of diabetes.
(5) Cardiac failure or diabetes has occurred in patients with left cardiovascular disorders following myocardial infarction and has been treated with β-receptor retardants and ACEI, with the application of lysinone receptor stressants, subject to the monitoring of serum potassium levels. The use of these drugs (I A) should be avoided in cases where the levels of seropolygia have increased (2.5 mg/dl for males, 2.0 mg/dl for females) or potassium haematium (5.0 mEq/L).
(6) Cardiac failure (NYHA) III or IV) or eGR <30 ml.min-1 (1.73 m2)-1 for chronic kidney patients with acute coronary syndrome, with gilloxin being better than gilloxin. If the use of beta-receptor retardants, ACEI and formaldehydesterone receptor stressor blood pressure is not controlled by the patient, some patients can use thiomers to control blood pressure (I B).
(7) The blood flow mechanics of ACA patients are stable with a blood pressure target of <140/90 mmHg (II aC). The target value of <130/80 mmHg at discharge is a reasonable choice (II b C). Blood pressure should be reduced slowly to avoid <60 mmHg to avoid a decrease in coronary artery injection and an increase in ischaemic blood.
High blood pressure.
