一例高血壓性心臟病的循證研究(文件)
【正文】 calcium channel blocker,CCB），即當使用上述藥物均不能控制血壓時，尤其在伴有心絞痛的情況下，可以增加二氫吡啶類CCB[4] 。3)如果不能耐受ACEI也可用ARB代替。2)有收縮功能障礙的病人最初應聯(lián)合使用血管緊張素轉(zhuǎn)化酶抑制劑（angiotensinconverting enzyme inhibitor，ACEI）和β受體阻滯劑。體檢常見心率增快，可有奔馬律或心尖區(qū)收縮期雜音。體檢發(fā)現(xiàn)心尖搏動增強，心臟向左下擴大，可聞及舒張早期奔馬律和心尖區(qū)收縮期雜音，肺動脈瓣區(qū)第二心音亢進，雙肺底部可有濕啰音。實際臨床工作中，對于診斷為穩(wěn)定性高血壓的患者，應全面地詢問病史和進行體格檢查，以發(fā)現(xiàn)是否存在其他并發(fā)癥和靶器官損害。一項來自西班牙的調(diào)查顯示，在946名高血壓患者中，%%，%%，只有25%的患者沒有發(fā)生任何形態(tài)學改變[1] 。事實上，高血壓是導致心臟和腦血管疾病最常見的原因。D 級：描述性研究及專家意見。根據(jù)證據(jù)的類型、研究的設計、方案實施嚴謹性和生物統(tǒng)計學的應用評價文獻的可靠性，可將文獻分為不同的等級：前三篇如下：1）Pewsner, D., et al., Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ, 2007. 335(7622): p. 711.2）Okin, ., et al., Baseline characteristics in relation to electrocardiographic left ventricular hypertrophy in hypertensive patients: the Losartan intervention for endpoint reduction (LIFE) in hypertension study. The Life Study Investigators. Hypertension, 2000. 36(5): p. 76673.3）Verdecchia, P., et al., Blood Pressure Monitoring. Task force III: Targetorgan damage, morbidity and mortality. Blood Press Monit, 1999. 4(6): p. 30317.密切相關的有以下兩篇： 1）Bangalore, S., et al., Betablockers for primary prevention of heart failure in patients with hypertension insights from a metaanalysis. J Am Coll Cardiol, 2008. 52(13): p. 106272.2）Khan, ., et al., The 2008 Canadian Hypertension Education Program remendations for the management of hypertension: part 2 therapy. Can J Cardiol, 2008. 24(6): p. 46575.在Cochrane圖書館檢索到相關文獻3篇：1）Jr Piller, ., Validation of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Participants Assigned to Doxazosin and Chlorthalidone. 2002.2）Houston, ., Hypertension and coronary heart disease risk factor management. 1993.3）Moser, ., Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials. 1996.將檢索結(jié)果匯成下表 各數(shù)據(jù)庫檢索結(jié)果數(shù)據(jù)庫檢索詞檢索結(jié)果All SRRCTGuidelinePubmedhypertensive heart disease AND diagnostic criteria
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