应避免对高血压合并外周动脉疾病患者快速强化降压(附五例病例分析)  

Avoid rapid intensive blood pressure reduction in patients with hypertension complicated by peripheral artery disease(with analysis of five case reports)

作　　者：赵芳 那开宪[2] Zhao Fang;Na Kaixian(Balizhuang Second Community Health Service Center,Chaoyang District,Beijing 100025,China;Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]北京市朝阳区八里庄第二社区卫生服务中心,北京100025 [2]首都医科大学附属北京朝阳医院,北京100020

出　　处：《首都食品与医药》2025年第7期41-43,共3页Capital Food Medicine

摘　　要：目的外周动脉疾病是高血压常见合并症,通过对五例高血压合并外周动脉疾病短时间快速降压,导致严重心血管不良反应发生的临床分析,认识到对高血压合并外周动脉疾病应避免短时间内快速降压,对高血压急症千万不能应用硝苯地平缓释片舌下含服方法快速降压。方法对五例高血压合并外周动脉疾病的患者,在20小时内,除了采用静脉点滴降压药物的方式外,还让患者舌下含服硝苯地平缓释片。结果将患者血压从180/110mmHg-210/110mmHg降至140/90mmHg以下,这一降压过程分别致使3例患者发生急性下肢血管缺血,1例患者发生急性冠脉综合征,1例患者发生脑梗死。结合文献复习,发现对高血压合并外周动脉疾病应避免短时间内快速降压,尤其是不能够采用舌下含服硝苯地平缓释片方法使血压快速下降,否则将导致不良心血管事件发生。结论高血压合并外周动脉疾病患者在降压治疗时需要谨慎,避免快速降压可能带来的不良事件,禁止应用硝苯地平缓释片舌下含服方法快速降压,应采取个体化、平稳的降压策略,并密切监测患者的反应。Objective Peripheral artery disease is a common complication of hypertension.Through the clinical analysis of five cases of hypertension complicated by peripheral artery disease in which rapid blood pressure reduction within a short period led to serious adverse cardiovascular reactions,it is recognized that rapid blood pressure reduction within a short period should be avoided in patients with hypertension complicated by peripheral artery disease,and the sublingual administration method of nifedipine sustained-release tablets should never be applied for rapid blood pressure reduction in hypertensive emergencies.Methods Five patients with hypertension combined with peripheral arterial disease were treated with intravenous infusion of antihypertensive drugs and sublingual administration of nifedipine sustained-release tablets within 20 hours.Results This medication method reduced the patients’blood pressure from 180/110mmHg to below 140/90mmHg.This blood pressure lowering process led to acute lower limb vascular ischemia in 3 patients,acute coronary syndrome in 1 patient,and cerebral infarction in 1 patient.Combined with literature review,rapid blood pressure reduction within a short period should be avoided in patients with hypertension complicated by peripheral artery disease,especially the method of sublingual administration of nifedipine sustained-release tablets to rapidly lower the blood pressure,otherwise adverse cardiovascular events may occur.Conclusion Patients with hypertension complicated by peripheral artery disease need to be cautious during antihypertensive treatment to avoid adverse events that may be caused by rapid blood pressure reduction.The sublingual administration method of nifedipine sustained-release tablets for rapid blood pressure reduction should be prohibited.An individualized and stable blood pressure reduction strategy should be adopted,and the patients’responses should be closely monitored.

关 键 词：高血压合并外周动脉疾病 快速强化降压 不良心血管事件 硝苯地平缓释片 平稳降压 

分 类 号：R544.1[医药卫生—心血管疾病]