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诊间日记:血压平稳了降压药就应该减量吗?

李青 2018-07-19 09:21:22

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天津市泰达医院李青

一个60岁的老年患者,高血压30年,一直用药治疗,但血压从来没有降至正常,现在已经出现了轻度肾损害。春节前看我的门诊,除了常规检查外,我还给她查了高血压三项、肾上腺CT等。结果发现一侧肾上腺饱满,醛固酮升高,诊断为原发性醛固酮增多症,继发性高血压,高血压性肾脏病。给络活喜+代文+螺内酯治疗。

昨天过来复诊,她一见到我就说,你开的药真好,用药不到一个礼拜血压就正常了,前一段时间测血压一直都很好,她现在把别的药都停了,只用代文。

我给她量血压,160/100mmHg。我问她,确定停药后血压正常吗。她说,没错,肯定正常。我告诉她刚测的血压值,她一听,说不可能。我看她不相信,就让她先到外面平静一下,再过来测血压。过了大约一刻钟,她进来又测血压,仍是这么高,她终于信了。我对她说,一说减药,我就知道血压肯定高了。

那血压平稳了降压药也不能减量吗?

高血压不是细菌感染,得了急性肺炎大量抗菌素治好后就可以停药。高血压的发生,有各种各样的因素。就原发性高血压而言,是遗传及不健康生活方式共同作用的结果,原发性高血压是个终身性疾病,需要终身用药治疗。就如同得了近视眼,大多数好不了,需要一辈子戴眼镜一个道理。

而她是原发性醛固酮增多症引起的继发性高血压,这种高血压本身就很难控制,需要联合用药,而且药量比较大。醛固酮增多症没治好,高血压不可能自我缓解。不增加品种和药量能控制血压就已经不错了,而她反而减药,这不是反其道而行之吗?

至于她血压正常,是用药的结果,或者说是药物控制下的平衡。坚持用药,就能长期维持这种平衡,而私自停药、减药或减量,这种平衡被打乱,血压就会再次升高。

临床上像她这样血压高了就吃药,血压正常了就减(停)药的"按需用药"的患者不是少数,其后果是,血压反复波动,人不但不舒服,而且容易发生心脑并发症。

健康提示:治疗高血压的目的是降压、保护靶器官;降压的最高境界是控制血压平稳达标。高血压治疗应该用长效药,每日一次按时用药,终身用药。

声明:本文授权中华网好医生频道发布,转载须注明“来源:中华好医生”,如需内容合作请联系中华好医生频道,电话:(010)52598588-8557,邮件:yi@bj.china.com,谢谢!
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