專題討論7:頑固型高血壓之診療
     Diagnosis and Therapy of Resistant Hypertension

程 序 表

S7-2
White Coat Hypertension, Masked Hypertension and Hypertension in the Elderly: Diagnosis and Therapy
林宗憲
高雄醫學大學附設醫院心臟血管內科

  TSOC hypertension guideline proposed a diagnostic algorithm emphasizing the importance of home BP monitoring and ambulatory BP monitoring for better detection of night time hypertension, early morning hypertension, white-coat hypertension, and masked hypertension. BP targets are <140/90 mmHg for all other patient groups, except for patients 80 years of age in whom a BP target of <150/90 mmHg would be optimal.
  For the management of hypertension, we proposed a treatment algorithm, starting with life style modification (LSM) including S-ABCDE (Sodium restriction, Alcohol limitation, Body weight reduction, Cigarette smoke cessation, Diet adaptation, and Exercise adoption). When drug therapy is considered, a strategy called “PROCEED” was suggested (Previous experience, Risk factors, Organ damage, Contraindications or unfavorable conditions, Expert's or doctor's judgment, Expenses or cost, and Delivery and compliance issue). To predict drug effects in lowering BP, we proposed the “Rule of 10” and “Rule of 5”.With a standard dose of any one of the 5 major classes of anti-hypertensive agents, one can anticipate approximately a 10-mmHg decrease in systolic BP (SBP) (Rule of 10) and a 5-mmHg decrease in diastolic BP (DBP) (Rule of 5). Preferably, when 2 drugs with different mechanisms are to be taken together, the decrease in BP is the sum of the decrease of the individual agents (approximately 20 mmHg in SBP and 10 mmHg in DBP). Early combination therapy, especially single-pill combination (SPC), is recommended. When patient's initial treatment cannot get BP to targeted goals, we have proposed an adjustment algorithm, “AT GOALs” (Adherence, Timing of administration, Greater doses, Other classes of drugs, Alternative combination or SPC, and LSM & Laboratory tests).