急性高海拔暴露后血压升高管理中国专家共识

Chinese expert consensus on the management of blood pressure elevation after acute high-altitude exposure

摘要

急性高海拔暴露后血压升高是一种常见的生理应激反应，但其过度升高或管理不当可诱发高血压急症、增加心脑血管事件风险。目前，国内外尚缺乏针对这一特殊情境下血压管理的系统性临床指导文件。为此，中国医师协会高血压专业委员会组织多学科专家，基于现有证据与临床实践经验制定了本共识。本共识系统阐述了急性高海拔暴露后血压升高的特点、核心病理生理机制及其与急性高原病的关联；提出了血压升高程度分级和高海拔暴露前心血管风险评估体系；重点探讨了不同作用机制降压药在高海拔环境下的疗效、安全性及循证证据；并构建了涵盖血压监测、高海拔预适应、血压升高干预及高海拔高血压急症处理的临床路径。本共识旨在为临床工作者提供规范、实用的决策参考，以提升对急性高海拔暴露后血压升高的综合管理能力。

Abstract

Elevated blood pressure following acute high-altitude exposure is a common physiological stress response. However, excessive elevation or improper management may precipitate hypertensive emergencies and increase the risk of cardiovascular and cerebrovascular events. Currently, there is a lack of systematic clinical guidance for blood pressure management in this specific context. To address this problem, the Hypertension Committee of the Chinese Medical Doctor Association convened a multidisciplinary panel of experts to develop this consensus, based on available evidence and clinical practice. This consensus systematically elaborates on the characteristics, core pathophysiological mechanisms, and association with acute high-altitude illness of blood pressure elevation after acute high-altitude exposure. It proposes a classification system for the severity of blood pressure elevation and a framework for cardiovascular risk assessment prior to high-altitude exposure. The document focuses on discussing the efficacy, safety, and evidence for antihypertensive medications with different mechanisms of action in high-altitude environments. Furthermore, it establishes a clinical pathway covering blood pressure monitoring, high-altitude pre-adaptation, intervention for blood pressure elevation, and management of hypertensive emergencies at high altitude. This consensus aims to provide standardized and practical decision-making references for clinicians to improve the comprehensive management of blood pressure elevation after acute high-altitude exposure.

关键词

高海拔 / 血压升高 / 急性高原病 / 高血压急症

Key words

high altitude / blood pressure elevation / acute high-altitude illness / hypertensive emergency

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基金资助

西藏自治区科学与技术厅揭榜挂帅项目(XZ202303ZY0004G)