长效降压药宜睡前服

长效降压药宜睡前服 近年在高血压病的降压治疗中，人们越来越重视根据血压昼夜节律的变化来选择最佳服药时间。 长效降压药是老年高血压病人比较适宜的降压药物，每日1次服药能够做到24小时稳定血压，既简单又适用，目前应用很广泛。 一般主张长效降压药在早晨7时左右服用，认为这样能较好的控制白天的血压升高和防止夜间容易发生的体位性低血压。然而，也有许多临床心血管病学者认为，将长效降压药放在睡前服亦未必不可。特别是呈现凌晨血压升高为特点的高血压病患者，于睡前服用将能更好控制血压波动，一般在9时左右服用为宜。长效降压药使得昼夜24小时血压更趋于稳定，可大大降低血压波动的危害。 为何晨起高血压患者宜将长效降压药放在睡前服呢,这是由于长效降压药的作用时间长，但起效的时间亦比较缓慢，用药3个小时后血药浓度方才逐渐升高至高峰，形成有效降低血压效应。这种效应可维持长达3—6个小时，而后将缓慢下降，并在其后的时间内保持比较稳定的降压作用，使得全天血压得以满意控制。这样算起来，在晚上9时左右服药，午夜 —6时仍然具有显著的降压效应。由此可使晨起高血压得到有效后达到血药高峰，直至凌晨4 控制，要比早晨起床后才服药更为科学合理。 睡前服用降压药，人们最大的担心是夜间体位性低血压的发生。尽管这种担心是必要的。但如果能明确自己的血压节律特点，一旦确定为晨起高血压，那么在睡前服用长效降压药，其控制效果将更加良好。临床观察结果证实，晨起高血压患者于睡前服用降压药，尚无发现血压过低现象，故而对此不必过于担心。 降血压宜选长效药 最近，我遇到一位老年高血 压病患者，因家人测得他血压较 高，给他舌下含服短效降压药硝 苯地平(心痛定)，谁知老人即刻面目潮红，心跳加快，不一会儿竞 晕厥过去。家人以为老人发生了 卒中，急送医院。 经仔细检查，老人并末发生 卒中，而是因为硝苯地平使血压急剧下降，引起反射性心跳加快， 从而使老人面目潮红、心跳加快， 进一步刺激交感 1 神经，加重心肌 缺血，致使老人不省人事。其实，无论是老年人还是中青年高血压患者，在降压治疗 时均切忌让血压急剧下降。因为，短效降压药有很 多弊端。 大家知道，血压得不到控制，会导致卒中、冠心病和肾功能衰竭等严重并发症。但 服用短效降压药，会使血压波动较大。血压很高时， 服用短效降压药，血压会降至很低;药效过后，血压又会生高。如此这般，血压忽高忽低，会引起脑供血 个足、缺氧、头晕等症状。 现代医学认为，高血压病 对心脏、脑、肾等脏器的损害程度大小，与全天24小时中血压升高的程度和时间密切相关。清晨醒 来，是高血压病患者发生各种心、脑血管病危险的 高峰时间，被称为“早晨危险时刻”。短效降压药往往不能有效控制“早晨危险时刻”及夜间的血压。 短效药需一天几次用药，患者不容 易坚持，少服、漏服现象严重。 可见，高血压病的有效治疗应保证24小时平稳降压，对比之下，选择长效降压药是最理想的; 长效药降低了全天24小时平均 血压水平，包括“早晨危险时刻”和夜间的血压，减少了高血压病患者发生心、脑血管病的危险。 长效药每天只需服用一次，患者的 依从性好，保证了治疗的正规化和长期性。 需要指出的是，高血压病讲究个体化治疗，不 同的患者需要用不同的方法。目前我国的降压药有 200多种，高血压病患者需在医生的指导下用药，才会取得最佳疗效，不要道听途说地自行选择、更换 药物。 当然，在急诊治疗高血压病时，为了使患者在 较短时间内降低血压，以免引起卒中、心力衰竭、肾功能衰竭等并发症，医生一般会采用起效快的短 效降压药，如卡托普利(开博通)、硝苯地平等。一般 在15分钟左右起效，使血压下降，以便再作进一步治疗。但在日常治疗中，还是服用长效药好。 作者:上海市高血压研究所主任医师 唐树德 降压药不良反应怎么防 冬季是高血压患者的危险季节，天气冷血管收缩，血压会有较大的波动，容易出现危险。专家提醒，坚持服药是治疗高血压最直接、最有效的手段，用药时要注意以下几个方面，以防止不良反应的发生。 初次服药逐渐加量 卫生部中日友好医院大内科主任柯元南教授告诉《生命时报》记者，有些高血压病人在 第一次服用降压药时，会感到心慌、气短、心前区不适、焦虑、不安、面红、头晕等。可能 2 原因有:病人对药物一时的不适应、药物固有的不良反应，同时还可能存在一定的心理作用。尤其是老年人、基础血压较高、长期高血压未经治疗的患者，会对压力反射不敏感，或者脑血管自动调节功能下降，更容易出现上述情况。 因此，高血压患者，尤其是老年人，开始服用降压药时剂量宜小，以后逐渐增加至治疗量。同时，未经医师允许，不得擅自加大剂量，否则易引起血压骤降。血压下降过快会引起脑供血不足，产生大脑缺血缺氧，甚至发生脑血栓。 另外，为了避免出现上述症状，也可选用长效降压药。较小的剂量即可达到与大剂量的普通制剂相同的效果，所以降压更为平稳，血压的昼夜变异小，还可以避免清晨血压的突然升高。而且，由于用药次数少，还能避免漏服药物。 此外，对于血压较高的患者，还可在医生指导下采用不同机制的药物联合用药，既能保证降压的效果，又不增加副作用。 多在早上服药 柯教授说，大多数人的血压呈“两高一低”或称为“长杓柄状”曲线，即上午9—10时为第一个高峰，下午6—8时为第二个高峰，午夜时分通常为最低。一般入睡后的血压要比白天下降20%左右。因此，高血压病人应选择在早上服药。 如果服用的是短、中效降压药，一天需服两三次，注意最好不在睡前服药。因为夜晚血压会自然下降，加上药物的作用，会导致血压大幅度下降。而且，夜间血流缓慢、血流量减少、血黏度增高，容易发生脑血管意外。 但是，有些病人的血压是晚上不下降，或者反而升高，被称作“非杓型”或“反杓型”，这样的病人就可以在睡前服药，或是选用上面提到的长效降压药，来避免这类问题的发生。 降压要终身服药 柯教授提醒，选择降压药应以西药为佳，不要看到说明书上写着副作用就惶恐不安。其实写清各种副作用，说明此类药物已经进行了严格的临床试验，是一种成熟的药物。切忌相信所谓无副作用、一剂根除的偏方、秘方。要知道迄今为止，还没有哪种药可以“根治”高血压。 柯教授说，降压的目的是为了减少心脑血管疾病的发生、延长寿命、提高生活质量，因此高血压是一种需要终身治疗的疾病，应该在持续平稳的降压措施下才能收到好的疗效。有些患者在血压恢复正常后就擅自停药，结果没过多长时间血压又出现回升，甚至会出现头痛、失眠、出汗、易激动等症状，严重时危及生命，因此，降压药不能随便停用。 3 当气温升高时血管舒张，大多数患者的血压会略有降低，个别患者甚至出现低血压。此时可以适当减量，甚至暂时停用，但要在医师指导下逐渐减量。 脉压增大怎么办 老张今年72岁，同时患有糖尿病、高血压、糖尿病肾病。64岁那年，老张患了高血压，服尼群地平、寿比山，保持低盐饮食，血压还算控制得好。但到了70岁，脉压开始增大，把降压药改为代文(缬沙坦)、欣然(硝苯地平缓释片)、倍他乐克、珍菊降压片，血压却还是控制得不理想。每天早上起床时，老张的血压为170/70毫米汞柱，服了降压药，加上3公里的步行锻炼后，血压会降下来;但下午2点血压又逐渐上升到170/70毫米汞柱，又出门步行3公里，血压降为135/65毫米汞柱左右。但第二天早上，血压又升高到170/70毫米汞柱。 对脉压增大的问题，老张很是烦恼，降了收缩压吧，舒张压也跟着下降。有一次，老张的舒张压降到50毫米汞柱，出现了头晕，这下他可不敢把血压使劲降了。 所谓脉压，是指动脉收缩压与舒张压之差(即收缩压-舒张压,脉压)，例如:血压为140/70毫米汞柱时，脉压,140-70,70毫米汞柱。一般来说，脉压大于60毫米汞柱就可认为脉压增大。 老年人血压易波动 老年高血压和单纯收缩期高血压患者常出现脉压增大的现象，其主要原因与动脉硬化、血管顺应性降低和血管弹性减弱有关。 除了脉压增大，老张的血压还有一个特点:一天内血压有较大幅度波动，这与老年人随年龄增大血压调控能力下降有关。脉压增大和一天内血压较大幅度波动都是老年高血压的特点。 平稳长效降压是关键 流行病学和循证医学研究证实，脉压增大可增加脑卒中、冠心病和心力衰竭的发生率。一天内血压经常有大幅波动，同样可引起心脑肾的损害。这就是为什么对高血压患者提倡平稳和长效(24小时)降压的原因，而不主张使用短效降压制剂，因后者有可能导致人为的血压波动。 老年人由于机体处于老化或衰老状态，血压调控能力下降，这是自然规律。因此，要彻 4 底改变上述情况确有一定难度。而且，目前尚无一种降压药只降收缩压而不降舒张压，这就使单纯收缩期高血压和脉压大的高血压治疗更为棘手。 调整用药，血压达标 根据中国2005年《高血压防治指南》的规定，由于老年人血压降低难度大，往往需要联合两种或两种以上降压药才能控制血压。一般情况下，将收缩压降至150毫米汞柱以下即可，如能耐受，还可进一步降低。 按理，患者老张同时患有糖尿病，有条件的话，血压能再降低一些更好，如收缩压降到130毫米汞柱。但在实践中发现，当收缩压降至较低，而舒张压低于50毫米汞柱时，老张却出现头晕现象，这可能与同时存在脑动脉硬化或脑动脉狭窄有关，当舒张压过低时，就出现脑部血液供应不足而导致头晕眼花。 因此，建议老张在降低收缩压的同时，要关注舒张压不能降得太低，以不低于60毫米汞柱为好。为了达到较平稳持久降压的目的，可在原治疗基础上作些调整，尽量服用长效降压药，如将倍他乐克(美托洛尔)改为1天1次的缓释制剂;适当加用利尿剂(如吲哒帕胺或氢氯噻嗪)，但需注意低钾和对糖代谢的影响。必要时可增加代文(缬沙坦)剂量，或加用血管紧张素转换酶抑制剂(如苯那普利、雷米普利等)。总之，把血压控制在约130,150/60毫米汞柱即可。老年人慎用长效降糖药 近年来，医生越来越多地发现，糖尿病与高血压两种疾病“狼狈为奸”，常常共存于患者体内。然而，糖尿病与高血压的用药原则却大有不同，比如，对于高血压来说，医生建议在经济条件许可的条件下尽量选用长效降压药，而对于糖尿病患者尤其是老年患者，为了避免低血糖引发老年痴呆等症，则尽可能不要服长效降糖药。 低血糖危害超轻度高血糖 广州医学院第二附属医院内分泌科李万根主任介绍，长效降糖药格列本脲(优降糖)因降糖快速持久且物美价廉，颇受老年糖尿病患者欢迎。一些血糖明显升高的糖尿病患者，服格列本脲治疗可在短时间内见到明显疗效。但是，值得注意的是，正是因为长效降糖药作用较强，如果血糖本来就不太高的病人过量服用就可能引起低血糖症，且可持续较长时间，轻者遭受出汗、颤抖、心率加快、饥饿、焦虑、紧张、软弱无力、面色苍白、流口水等症状的折磨，身体素质较差的老年病人就可能出现昏迷。从临床上来看，近年来急诊室救治的严重低血糖症，其病因多是因为滥服优降糖等磺脲类降糖药。 更为可怕的是，这种伤害常常是“隐形”的。优降糖等长效降糖药所致的低血糖虽然可 5 持续24小时以上，但交感神经过度兴奋的表现却并不一定出现，再加上大多数老年糖尿病患者伴有自主神经损害，低血糖早期症状往往不明显。 睡眠中低血糖不易被发现 因此，老年糖尿病患者最好应在医生的指导下选用作用时间较短的降糖药，而且应从小剂量开始。 还应注意的是，服用长效降糖药，即使白天没有出现低血糖的问题，也很容易在夜间零时~3时发生血糖过低。在夜间空腹的情况下，健康人可以动员脂肪、蛋白质和肝脏中的糖元出来转化成葡萄糖，供人体脑组织利用，不会发生低血糖。糖尿病人的上述调节功能减退，而且由于降糖药刺激胰岛素持续高水平分泌，低血糖就容易在夜深人静时不请自到。而这时候恰恰人在熟睡，低血糖不易觉察，当病人意识到低血糖，从睡梦中饿醒找东西吃的时候，血糖水平可能已经低于50mg/dl，脑组织会由于得不到糖的供应而发生功能障碍。 因此，糖尿病患者如果夜间出现震颤、出汗等症状被惊醒，应意识到可能是低血糖征象，经血糖测试确定。一旦证实夜间低血糖，应加一顿点心，减少口服降糖药或者睡前胰岛素剂量。对低血糖反应迟钝者，即血糖虽低但无震颤、饥饿、心慌等症状，必须经常监测血糖。 某些中成药中也含优降糖 某些中成药中也含有格列本脲成分，如消渴丸每10粒含强效磺脲类优降糖1片，用量不当一样发生低血糖。今年8月，广东省食品药品监督管理局公布了第二季度药品抽检结果公告。结果显示，降糖中成药中随意添加西药成分的现象比较突出，如某批次降糖中成药“糖尿乐胶囊”、“降糖宁胶囊”中发现了西药成分“格列本脲”，由于没有标识，使用前很难发现。识别的方法是:如果发现使用这些制品能使血糖明显下降，或服用后几小时发生心慌、饥饿感等，甚至昏迷，请慎用。 李主任提醒，对糖尿病的治疗不能单纯依赖药物，而忽视饮食和其他治疗。糖尿病的治疗是综合治疗，饮食控制、运动锻炼和药物治疗缺一不可。只有在饮食控制和运动锻炼的配合下，药物治疗才能取得良好的降糖效果。对于一些刚刚确诊的轻度糖尿病患者来说，更应先饮食及运动治疗，约一个月后仍不达标者，才考虑药物治疗。 有些病人认为用药之后，多吃点也无妨，并试图通过增加药量来抵消多余进食，这是很不明智的。这样做的结果，容易使身体发胖，加重胰岛素抵抗，不利于血糖控制。 老年人服降压药需慎重 避免不良反应 6 文,首都医科大学心血管研究所 丁枭伟 65岁以上的人有三分之二患有高血压，是高血压控制率最低的一组人群。包括单纯收缩期高血压在内的老年高血压患者，治疗时应遵循高血压治疗的一般性原则。对某些患者，减少起始药物剂量可避免不良反应。多数老年患者需采用标准剂量的多种药物联合才能达到目标血压。 抗高血压药物已达百十余种，现在常用的有五大类:(1)利尿剂;(2)钙拮抗剂;(3)血管紧张素转换抑制剂;(4)血管紧张素受体拮抗剂;(5)β受体阻滞剂。 对老年人应用利尿剂可引起电解质紊乱、脱水、排尿障碍、高脂血症、低钾及糖耐量的降低;应用β受体阻滞剂易导致心力衰竭或心脏传导障碍。因此，给老年人用药需非常慎重。应用时要做到——— ?逐步降压; ?因人而异; ?除严重高血压外，给药应从单药开始; ?单一给药降压不明显的，联合用药优于单一大剂量给药; ?降压药服用过程中不能突然停药或突然撤除某些药物，如β受体阻滞剂(倍他乐克，阿替洛尔等); ?用药剂量一定要合适; ?降压药应选择适合自己的药物，新药未必就好; ?不要用影响情绪和思维的药物，以免干扰日常生活; ?多数病人需长期坚持服药，不要轻易改变，最好服用一天一次的长效降压药物。 收缩期高血压该用什么药 单纯收缩期高血压又称动脉硬化性高血压，其诊断标准是收缩压大于140毫米汞柱，舒张压小于90毫米汞柱。这类高血压多发于60岁以上老年人，少部分发生于青年人高动力循环者。最常见原因是老年人大动脉弹性和顺应性降低，脉压增大。有不少人错误地认为单纯性收缩压高是人体血管老化的标志之一，是血管弹性减退所致的良性过程，即使高点不算啥。其实不然，近年来流行病学资料显示，老年高血压患者收缩压越高，心脏血管并发症就越多， 7 死亡率就越高，特别是脑卒中更为多见。因此患者最好将血压降至130/85mmHg以下，至少也应在140/90mmHg以下。一旦明确诊断应立即给予药物治疗。 如何选择药物 目前推荐用于老年单纯收缩期高血压的降压药有以下几种。 利尿剂主要用于轻中度高血压，尤其在老年人高血压或并发心力衰竭时。糖尿病和高脂血症患者注意避免低血钾和心律失常等不良反应。呋噻米(速尿)仅用于肾功能衰竭时。 钙离子拮抗剂可用于各种程度的高血压，尤其在老年人高血压或合并稳定型心绞痛时。优选长效制剂，如非洛地平、硝苯地平。在稳定型心绞痛和急性心肌梗死时禁用速效二氢吡啶类钙拮抗剂。 血管紧张素转换酶抑制剂主要用于高血压合并糖尿病，或并发心脏功能不全、肾脏损害有蛋白尿的患者，但肾功能衰竭患者禁用。 β,受体阻滞剂主要用于轻中度高血压，尤其在静息时心率较快(大于80次/分)的患者或合并心绞痛时。慢性阻塞性肺病与周围血管疾病患者禁用，1型糖尿病患者慎用。 用药注意事项 ?尽量服用每日1次即能平稳降压的长效降压药，如依那普利与硝苯地平缓释剂联合应用。 ?避免降压过快而影响主要器官(心、脑、肾)血液灌注，更不要为求过快降压而随意增加服药剂量或用药次数。 ?防范药源性低血压，可小剂量联合用药。在用药最初两周内每日测血压1,2次，以了解有无低血压倾向。 ?若按上述处理后，降压效果不理想，一定要及时就医，不得擅自换药或增大药物剂量。 除以上药物治疗，科学合理的膳食，控制体重，增加活动，减轻精神压力，戒烟限酒也很重要。 中老年用药有隐患 上海用药重点人群———社区中老年人用药情况“家底”初步摸清。昨天，上海市药品不良反应监测中心公布了中老年人群药物流行病象的首份课题调研抽样，结果发现，中 8 老年人慢性疾病用药级别较低，可抗菌药级别却令人惊奇地高。造成这一用药安全隐患的最大原因是经济因素，因为中老年人全年收入的30—40,全部用于购买慢性疾病用药。 这也是全国首次出现这一报告，为评估药品上市后用药安全提供了技术平台，填补了用药安全指导缺乏具体手段和评价方式的空白。78.16,每月需要服药 报告显示，91.56,的中老年人一年内服过药，30天内曾经用药的比例也高达78.16,，且慢性疾病的患病率较高。其中，心脑血管疾病占46.20,，而绝大多数又是高血压;其次是呼吸系统疾病和骨伤科疾病，分别占10.65,和9.02,。中老年人群所患肿瘤的种类中又以消化系统肿瘤最多见。此外，这些疾病格外容易引起中老年人住院，引发更昂贵的住院费用。 与此同时，中老年人家庭人均月收入普遍较低，每月500,1000元的占33.7,，人均月收入小于500元的占49.2,。虽然48.7,和42.8,的中老年人分别享受医疗保险或合作医疗，但仍有31.58,的看病和住院费用需要自己支付。 在服用的慢性疾病用药中，抗高血压药物最多，但占绝大多数的是比较老的复方制剂，更好的新型抗高血压药物少人问津;治疗糖尿病药物也是较老的二甲双胍;而抗菌药物则使用的级别很高，主要是头孢拉定。然而恰恰是头孢拉定成了药品不良事件的主角。 上海市药品不良反应监测中心副主任杜文民说:“用老配方药主要是便宜。”据了解，使用较为普遍的复方降压片一天用药只要一二毛钱，而一天一次的长效降压药每天最低需要四五元。瑞金医院高血压科主任、上海市高血压研究所所长朱鼎良表示，降压药的选择主要是针对病情、药物适应反应和病人经济情况决定。目前用药的趋势是两种，其一是长效降压药，其二则是新配方的复合制剂，但这两类药大多以进口药和新药为主，价格比较昂贵。 用药知识严重匮乏 造成安全隐患的第二个原因是中老年人用药知识匮乏。这部分人群文化程度偏低，初中以下文化程度占80.9,，其中还有29.9,的文盲或半文盲。绝大多数中老年人遵医嘱服药，而注意药品说明书，按说明书使用的较少，还有相当一部分人服用剩余药品或亲戚朋友送(要)来的药，而且约60,的人不重视生产企业、批准文号、产品批号，为安全用药埋下隐患。杜文民说:“医生指导用药的责任心必须加强，因为他们是中老年人最信赖的人。” 2002年6月起至今，上海市药监局12个分局直接入户调查，完成了20多万份中老年人群药物流行病象调研，首先完成的抽样报告数据来自金山区，3352名中老年人为样本人群。药品不良反映监测中心杜文民说:“尽管报告有一定的地域特点，但其数据比例与其他区县 9 的相差无几，具备相当的普遍意义。” 年底建立30万人用药数据库 据了解，上海地区中老年人群药物流行病象调研今年还将继续，主要有浦东新区、青浦等地，到年底将全部完成30万人的静态调查，并建立30万名以上的中老年人用药数据库。明年起，数据库将与医疗机构电子系统联接，建立自动化记录联接系统，动态监控用药安全。这套网络健全后将对社区中老年人用药、政府医保政策的完善、以及企业研究药品市场都有深远的影响。 专家称:“睡前莫服降压药”不是绝对的 长效降压药是老年高血压病人比较适宜的降压药物，每日1次，既简单又方便，目前应用很广泛。一般主张长效降压药在早晨7时左右服用，认为这样能较好地控制白天的血压升高和防止夜间容易发生的体位性低血压。然而，也有许多临床心血管病学者认为，将长效降压药放在睡前服亦未必不可。特别是呈现凌晨血压升高为特点的高血压病患者，于睡前服用将能更好控制血压波动。长效降压药使得昼夜24小时血压更趋于稳定，可大大降低血压波动的危害。长效降压药的作用时间长，但起效的时间亦比较缓慢。在晚上9时左右服药，午夜后达到血药高峰，直至凌晨4—6时仍然具有显著的降压效应。由此可使晨起性高血压得到有效控制，这要比早晨起床后才服药更为科学合理。 对于脑血管病患者的降压治疗，专家推荐应用血管紧张素转换酶抑制剂(“普利类”)和噻嗪类利尿剂降压。这类患者血压自身调节潜力明显降低，甚至日夜血压波动曲线消失。颅内血流主要靠动脉血压水平调节，即颅内灌注压随着动脉血压波动，因此，早晨或晚上服药均关系不大。依那普利国外研究结果提示，晚上服用咳嗽发生率显著降低。但利尿类降压药物如吲达帕胺、双氢氯噻嗪等早上服药为好，这样可使晚上少上厕所。 每个人的血压都有自己的血压生物钟调节规律，并非千篇一律都是“昼高夜低”，最好是能在医生的帮助下进行24小时动态血压监测，找出自己的血压变化规律，把降压药物服在最高血压来临前2小时左右。一旦确定自己为晨起高血压，将降压药物放到凌晨醒后服用更为科学;对于少数夜间血压高的患者(夜间头晕头痛，无法入睡)，可以采用长效降压药物在睡前服用。 10 有些降压药物剂型要求必须晚上临睡前给药，例如国外开发的维拉帕米脉冲释放制剂，临睡前服用，次日凌晨4点左右，突然脉冲释放，药物出现在血压升高的危险时刻，体现了时辰治疗学的要求和高技术定时释放的技术优势。对于络活喜等，已有大宗研究，表明治疗作用跟服药时间段无关，只要每日定时服药即可。 高血压病患者的注意事项 一、2005高血压指南 血压水平的定义和分类 影响预后的因素 心血管病的危险因素:1、收缩压和舒张压水平; 2、男性>5 5岁; 3、女性>65岁;4、吸烟;5、血脂异常6、早发心血管病家族史7、腹型肥胖8、或肥胖?C反应蛋白?1mg/dl 二、血压升高的异常因素 人的血压在一天之内，并不是恒定不变的，而是在一定的范围内波动。发生在血压本来 如动脉硬化)身上，就明显增高的高血压病人，以及年事已高、血管壁弹性差或已有损伤的人( 情况更加危险。 1、全身使足劲儿抬、扛、背、挑重物时:血压急剧显著增高，收缩压可升高6(7- 13.3kPa(50-100mmHg)，甚至更高，但停止用力时，血压便会迅速恢复正常。 2、暴怒、极度恐怖或精神极度紧张时:血压可骤升，收缩压可升2.6-10.7kPa(20-80mmHS) 或更高些，舒张压亦明显增高。 3、狂喜、哈哈大笑等极度兴奋时:血压亦可骤升，升高的幅度与精神极度紧张相近。 4、大小便时，尤其是便秘者:排便时间较长或用力过猛时，血压会显著升高，收缩压可升高4.0-9.3kPa(30-70mmHg)或更多，舒张压亦升高1.3-4.0kPa(10-30mmU9)或更高。 5、咳嗽，尤其是阵发性剧烈咳嗽时:血压可突然升高，升高幅度与咳嗽剧烈程度成正比。最高时收缩压可升高8(0kPa(60mmHg)左右。 6、高声连续讲话(讲演、讲课):情绪激动地辩论时，血压会骤升，幅度同极度兴奋相似。 7、饮酒，大量饮用烈性酒(酗酒):可使一些人血压短暂地骤升，幅度亦较大，是酗酒诱 11 发脑中风的主要原因。 三、高血压药物治疗及注意事项 1、服利尿剂期间，记住遵医嘱定期复查血钾，因为利尿剂可引起低血钾，严重的可致命。 2、各种药物的禁忌症 3、长期服用降压药的患者，不要突然停药，即使血压过低也应在医生指导下逐渐减量。 服药“三防”: 防停药综合征:有些人服用降压药后，看到血压恢复正常，便擅自停药，结果几天后血压又上升，且出现出汗、头痛、失眠、易激动等症状，谓之停药综合征。几乎所有降压药都有可能产生此种不良反应; 防低血压:假若服用降压药不当，例如过量服用可使血压骤降，出现脉搏增快，头晕目眩，甚至短暂意识丧失，谓之低血压综合征; 防夜间综合征:人体的生物钟规律是，血压在一天之中有“两高一低”现象，入睡后自然下降血压下降，过低使大脑缺血，诱发缺血性中风，按医嘱行事不要自作主张。晚睡时轻症高血压不要服用降压药，中度以上高血压病人须减量服用，约为白天量的1,3即够，以免夜间发生中风等悲剧。 四、高血压非药物治疗 1、保持愉快心情。紧张的情绪会使我们的神经系统释放许多导致血管紧张、收缩的化学物质，导致血压升高。相对于享受田园风光的农村人、体力劳动者来说，都市人和脑力工作者由于生存空间、感情空间的狭小而承受较大的精神压力，适当的心理减压和外出休闲放松对控制血压很有必要。 2、控制饮食。食物中的盐和脂肪会促进血压的升高，提倡清淡饮食。米饭也不主张吃太多，建议每顿吃到七八分饱即可，以免血糖太高。鼓励多吃蔬菜，可以达到减轻体重、控制血脂、降低血糖、通畅大便等多种目的。可能有降压作用的蔬菜有芹菜、茼蒿、大蒜、洋葱、茄子、木耳、香菇等。 3、增强运动。适当的运动可以缓解紧张的情绪、调节交感神经和副交感神经的兴奋平衡、改善大脑皮层功能、通过出汗排出血管内多余的钠和水来降低过高的血压，运动还可以通过一些目前不完全明确的途径来舒张血管达到降压目的。有一些服用降压药治疗的轻度高血压患者，后来在我的鼓励下每天爬白云山，经过一个月的坚持，逐渐停用药物，血压长期显示在正常范围。通过控制饮食和增加运动，可以减肥、减体重，降低血压。 12 4、避免寒冷。寒冷会使全身血管收缩，导致血压升高。高血压病患者应该注意保暖，尤其冬天的早晚或寒潮来临时，早加衣服。多用温水洗脸沐浴，少接触冷水。 5、提高睡眠质量。良好的睡眠可以使血压更加平稳，可通过运动、休闲等方式来促进睡眠，必要时可以服用安眠药。通过以上方法能够在一定程度上降低血压，减少治疗高血压的用药量。 严格防治高血压病及其并发的心脑血管病如心绞痛、心梗和中风等，对高血压病人的健康长寿格外重要。专家提出的健康处方“五个三”，就是“三个半分钟”、“三个半小时”、“三松”、“三戒”和“三少”、“三个半分钟”是:夜间起床时，醒来睁开眼睛后，继续平卧半分钟;再在床上坐半分钟:然后双腿下垂床沿半分钟，最后才下地活动。“三个半小时”是:早上走半小时;中午睡半小时;晚上散步半小时。世界卫生组织曾在国际睡眠会议上强调了午睡的好处，但午睡时间不能超过半小时。世界卫生组织认为:最好的运动是步行，特别提醒心脑血管病人。 运动“三戒”，合理运动是防治高血压的良方之一，但宜选择节奏缓慢、运动量小、容易掌握的项目，如太极拳、医疗体操、步行、气功等，早晚各1次，每次30分钟左右，以不疲劳为度。 一戒量多，特别不宜从事活动强度较高的项目，如旋转、跳跃、弯腰、憋气、用猛力等，否则可能加重心脑血管疾病，无助于病情康复。 二戒成瘾。运动一旦成瘾，可能增加运动量，延长运动时间，同样有加重病情之风险。 三戒比赛。比赛易使人情绪紧张、激动，从而促发血压升高而发生意外。 穿戴“三松”:1、裤带松: 2、鞋袜松: 3、衣领松: 进餐“三少”:1、热量少: 2、脂肪少: 3、盐要少: 高血压患者的饮食 1、碳水化合物食品:适宜的食品——米饭、粥、面、面类、葛粉汤、芋类、软豆类应忌的食品——番薯(产生腹气的食品)、干豆类、味浓的饼干类。 2、蛋白质性食品:适宜的食品——脂肪少的食品(嫩肉肉、牛、猪的瘦肉、白肉鱼)、蛋、牛奶和牛奶制品(鲜奶油、酵母乳、冰淇淋、乳酪)、大豆制品(豆腐、纳豆、黄豆粉、油豆腐、青菜丝豆腐)。 应忌的食品——脂肪多的食品(牛、猪的五花肉、排骨肉、鲸鱼肉、鲱鱼、鳗鱼、金枪鱼等)、加工品(香肠等)。 13 3(脂肪类食品 适宜的食品——植物油、少量奶油、沙拉酱。应忌的食品——动物油、生猪油、熏肉、油渍沙丁鱼 4(维生素、矿物质食品 适宜的食品——蔬菜类(菠菜、白菜、胡萝卜、番茄、百合根、南瓜、茄子、黄瓜等纤维少的)，水果类(苹果、桃、橘子、梨、葡萄、西瓜等)，海藻类、菌类、水果类、蔬菜类生吃会产生腹气，必须软煮或做成酱;应忌的食品——纤维硬的蔬菜(牛旁、竹笋、玉米)、刺激性强的蔬菜(香辛蔬菜、如芥菜、葱、芹菜类)。 5(其他食品:适宜的食品——淡红茶、酵母乳饮料;应忌的食品——香辛料(辣椒、芥末、咖喱粉、酒类饮料、咖啡、浓红茶等)、碳酸饮料、盐渍食品(咸菜类、咸鲑鱼、 咸鱼子、腥鱼子、糖酱油煮的菜、酱菜类)。 五、高血压患者急救 急救措施 1、血压突然升高，伴有恶心、呕吐、剧烈头痛，甚至视线模糊，即已出现高血压脑病。这时家人要安慰病人别紧张，卧床休息。家中若备有降压药，可立刻服以另服利尿剂、镇静剂等。若经过上述处理，症状仍不见缓解，要及早护送病人到附近医院急诊治疗。 2(发生心绞痛，甚至心肌梗塞或急性心力衰竭。病人多在劳累或兴奋后出现剧烈的心前区疼痛、胸闷，可放射至颈部、左肩背或上肢，重者有面色苍白、出冷汗。遇着上述情况时，应叫病人安静休息，备有硝酸甘油一片舌下含服，或打开一支亚硝酸异戊酯吸入。家中如备有氧气袋，可同时予以吸入氧气。如症状不见减轻应迅速通知急救中心或备车前往医院。 3(如病人突然心悸气短，呈端坐呼吸状态，口唇发绀，伴咯粉红泡沫样痰时，要考虑有急性左心衰竭。应吩嘱病人双腿下垂，采取坐位，予以吸入氧气，并迅速通知急救中心。 4、高血压患者在发病时，会伴有脑血管意外。病人突然出现剧烈头痛，伴有呕吐，甚至意识障碍和肢体瘫痪，此时要让病人平卧，头偏向一侧，以免意识障碍伴有剧烈呕吐时，呕吐物吸入气道，然后通知急救中心。 5、高血压急症，指原发性或继发性高血压在发展过程中，或在某些诱因作用下，血压突然增高，无论有无症状，收缩压超过26.7千帕(200毫米汞柱)和(或)舒张压超过18.7千帕(140毫米汞柱);或血压虽为中度增高，但并发了急性左心衰竭、主动脉夹层动脉瘤、急性心肌梗死或急性脑血管病，均为高血压急症，如不及时抢救，则可危及生命。 家庭急救原则:迅速降低过高的血压，积极防治并发症。 14 (1)去除诱因，立即休息，保持安静，避免刺激。 (2)可抬高病人的床头30?角，以达到体位性降压的目的。 (3)保持呼吸道通畅，把头部偏向一侧，以免呕吐物吸入呼吸道而引起窒息。 (4)必要时吸氧。 (5)药物应用: 1、硝苯吡啶(心痛定)10毫克一20毫克舌下含服，5分钟内开始降压，30分钟后血压平 均可下降5.3,3.3千帕(40,25毫米汞柱)，可维持3小时以上。本药可扩张周围的血管和 冠状动脉，从而使血压下降。适用于各种病因引起的高血压急症，且降压作用迅速。 2、硝酸甘油0.6毫克-1.2毫克舌下含服，3分钟起效，维持时间短，可重复使用。 本药可扩张周围血管及冠状动脉，尤适用于伴有心绞痛或胸闷者。 3、安定2.5毫克-5毫克口服，用于烦躁不安者。 (6)尽快向急救中心呼救。 送往医院时注意: 病人症状已基本缓解。 血压稳定在安全范围内。 严重并发症得到有效控制。 必要时吸氧。 保持静脉通道 途中严密监护患者的神志、呼吸、脉搏、心率、血压及并发症等病情变化。 六、老年人高血压注意事项 1、有的老年人由于没有症状，不愿意接受治疗，应该更详细地加以说明，以征得配合。2、由于老年人群已经适应了高血压状况，此时采取降压治疗或者由于药物的本身作用，反而容易出现不舒服的感觉，所以在降压治疗过程中应循序渐进，避免血压的大幅度波动。 3、单纯收缩性高血压的治疗比较困难，需要更多的耐心才能取得较好的效果。 4、老年人的代谢减慢，更容易出现对一些药物的不良反应，所以药物的剂量可以适当调整。 5、在低盐饮食方面要适当，不必要求太严格。 6、考虑到体位性低血压的特点，要避免使用可能会引起体位性低血压的药物，如神经节 15 阻断药物，该类药物现在已较少使用，但是复方降压片等一些复方制剂中可能含有上述成分。 7、在老年性高血压的药物治疗中，多采用以下几种药物: ?利尿剂;?钙拮抗剂:?p受体阻滞剂:?血管紧张素转换酶抑制剂。在以上药物治疗中，一般先采取单一药物，往往就可以达到降压效果。 七、高血压治疗常见误区 1(担心血压降得过低。根据现代医学研究显示，血压在理想范围内越低越好，只要平稳地将血压降至目标水平以下，既可减轻症状，也减轻各种脑血管事件的危险性。 2(对有并发症时应将血压降得更低认识不足。按现代高血压控制标准，凡合并糖尿病、高血脂、并发糖尿病、肾病时，目标血压水平应降得更低，但目前许多人对此认识不足，未能采取积极措施达到目标水平，因而心脑血管事件仍居高不下。 3(对非药物疗法重视不够。高血压的防治应是以非药物疗法，如调整生活方式、低盐、低脂、戒烟限酒及运动锻炼等，作为防治基础，并在此基础上服用降压药物，控制血压在理想或目标水平。但现实中许多患者过多依赖于药物而对非药物疗法不够重视，如边吸烟边降压者大有人在，既影响降压药疗效又使心脑血管事件的危险存在。 4(血压降下来后不一定再用药。许多患者服药总是断断续续，使得血压反复波动，结果心脑血管事件有增无减。造成用药中断的因素很多，其中关键的一个因素是对高血压病必须长期治疗认识不足，因而形成一种误识，即血压一旦降了下来便以为可以停药了，担心用药时间长会引起不良反应。 5(治病心切，喜欢作用快的降压药。其实，多年的高血压无需立即降，应该缓慢，平稳，并能在全日24小时平稳降压，对此，长效降压药可达此目的，因而老年高血压病人应尽量用每日一次的长效降压药。 6(不用药亦可降压。这是近年来不少保健品及降压器具如降压表、降压帽、鞋垫等的广告中常用的一句话，事实并非如此。不要轻信降血压治疗仪作用，且不说这些器具的疗效并不可靠，就绝大多数高血压病人来说，降压药治疗是最有效、有益的选择，不用药才是误区和不明智的。 7(新药、贵药就是好药。这也是一个极为普遍的误识。目前新型降压药发展很快，品种很多，如何选用是有讲究的。其关键在于遵医嘱办事，在医生指导下用药，不要道听途说，盲目追求新药、贵药。 8(忽视血压监测和记录。在降压治疗过程中，许多患者因各种原因长期不监测自身血压 16 变化，这也是一种误区。这是因为目前的降压原则中十分强调个体化用药。 9(不要凭自我感觉增加或减少剂量，以免出事。自我感觉是不可靠的，如头晕，血压高时可出现头晕，而血压过低时，也会感到头晕。不要自己擅自更改药物的种类或剂量。不要轻信传言和广告，切莫停用降压药而改用偏方、秘方或用保健品代替降压药，以免造成严重后果。 中南大学湘雅医院心内科莫龙 您该选用哪种降压药 降压药应用的几项指导原则 1、药物的剂量应当从小剂量开始，切不可急于求成，不分青红皂白地加大剂量，造成血压的大起大落或产生严重副作用，甚至威胁生命。 在用药过程中，单个药物有效，但不够理想时，可以考虑适当加大剂量;如单个药疗效很差或病人不能耐受时，则应首先考虑换用另一个非同类药物并使用小剂量，而不是加大第一个药物的剂量。 2、长效降压制剂是目前高血压治疗的新趋势。一大批药物已应运而生，如长效心痛定、氨氯地平、硝苯地平(拜新同)、非洛地平、血管紧张素转化酶抑制剂(ACEI)的多种制剂及血管紧张素受体抑制剂(ARB)等，此类药物均为每日服药1次，可以维持全天候降压。它的优点是:服用方便，病人顺应性好，避免了血压的昼夜波动。这对于降低心血管病的危险性和防止靶器官的损害都是有益的。 3、适当地联合用药。联合用药的目的是最大限度地提高药物疗效和避免副作用，实践证明，为使血压降到满意的目标值，仅仅使用单个降压药是不够的，联合用药能使大多数高血压患者取得满意疗效。一般两种药物的联合已有明显的效果，需要3种、4种药物联合的是少数。但药物的联合也不是“拉郎配”，而应严格遵守科学的客观规律。世界卫生组织推荐的5钟有效联合的方案是:(1)利尿剂+β受体阻滞剂;(2)利尿剂+ACEI(或ARB);(3)钙通道阻滞剂(二氢吡啶类)+β受体阻滞剂;(4)钙通道阻滞剂+ACEI;(5)α受体阻滞剂+β受体阻滞剂。 如何选用降压药 17 说到降压药，人们首先关切的是药物疗效与不良反应。一般选药的思路是;对年轻患者选用β阻滞剂，中老年人多选钙拮抗剂;有水、钠潴留倾向的女性和肥胖者多选用利尿剂;有靶器官(如心、脑、肾等)明显受损者则多选用ACEI。这些基于实践的经验之谈，为降压药的选用划出了一个思考的轮廓。然而，降压药的选用也是随着医药学的不断进步及自身病情的改变而变化的，因此，最重要的原则是必须根据个人的不同情况，实行高度的个体化原则，用药前一定要全面地考虑和衡量自身与用药有关的病史与临床因素，以免顾此失彼、半途而废。应该考虑的相关因素是:(1)自身存在的心血管病危险因素，如高脂血症、吸烟、肥胖、早发心血管病家族史等;(2)有无高血压的靶器官损害，如左心室肥厚、蛋白尿或血浆肌酐升高、视网膜动脉狭窄;心脑血管病、肾脏病、糖尿病;(3)相伴随的其他疾病、可影响某些降压药使用者;(4)有无同时应用其他药物可能与降压药产生相互作用者;(5)经济承受能力。 处理一些降压药常见副作用的简单方法是:ACEI引起咳嗽的患者，改用ARB，可保无忧。硝苯地平常见的副作用是面红、心悸(心动过速)，可在医生指导下考虑伍用β受体阻滞剂。利尿药疗效确切，但它可致低钾、糖耐量降低及心律失常，解决的办法是使用小剂量，如双氯噻嗪可用12.5毫克,每日1,2次;吲哒帕胺对心脏有保护作用，对糖与脂肪代谢无不良影响，其临床应用较广，但也可导致低钾，可用1.25,2.5毫克每日1次。必要时可适当补钾， 日。或多进食香蕉、柑橘，绿叶蔬菜等含钾较多的食物。 1~3克/ 对于有合并症和并发症的高血压患者，其用药牵涉到多个学科，应认真听取专家的意见。应注意的是:(1)合并冠心病患者，降压药的选择应兼顾到动脉粥样硬化、心绞痛、心肌梗死的防治。对无心肌梗死病史、有心绞痛的患者，应选用β阻滞剂、钙拮抗剂(最好是长效制剂)、ACEI。有心肌梗死病史的患者，可用β阻滞剂、ACEI，既能有效降压，又能对心肌梗死施行二级预防。可有效地减少再次心梗及猝死的机率并降低总死亡率;(2)合并糖尿病患者，应避免使用噻嗪类利尿药，必须使用者，可选用吲哒帕胺，因其对血糖、血脂及电解质无明显影响。β阻滞剂可掩盖胰岛素治疗过程中因用药过量引发的低血糖症状，不宜使用。故一般可选用α阻滞剂、ACEI及钙拮抗剂;(3)合并高脂血症患者，降压药的选择以钙拮抗剂、ACEI、α阻滞剂为宜。不宜使用β阻滞剂和噻嗪类利尿剂，除以上已提到的原因外，据研究，这2类药物在长期使用时，还可分别导致高密度脂蛋白降低和低密度脂蛋白升高，这不利于动脉粥样硬化和冠心病的防治。而α阻滞剂能抑制肝脏合成胆固醇，并提高组织细胞低密度脂蛋白酶的活性，这对高脂血症的治疗是极为有利的;(4)合并高尿酸血症患者(资料表明，高血压合并高尿酸血症的发生率约为30%)，6大类降压药中，β阻滞剂对尿酸代谢影响 18 较小，钙通道阻滞剂和ACEI可增加尿酸的排泄，而噻嗪类利尿剂则可使使血尿酸升高。 总之，高血压的治疗是一个长期的、科学的持久战，必须步步为营，稳扎稳打，定期监测血压，冷静对待不良反应。不论是单个用药或联合用药，其用量减量、停用或更换药物均应认真接受医生指导。 教你认识降压药 目前高血压病人常用的抗高血压药物，按照药理的作用，可以分为六大系列。 利尿剂 利尿剂是使用最早，最常用的降压药物，降压作用显著，对老年人收缩期高血压和肥胖的高血压病人降压尤为适用，但不适宜痛风、高脂血症及糖尿病病人。可与其他各类抗高血压药物合用，能增加降压的效果。由于长期应用易引起低血钾等不良反应，现在已经很少大剂量地使用。常用的利尿剂按照其降压作用的强弱，分为高效利尿剂(速尿、利尿酸)，中效利尿剂(双氢克尿噻、氯噻酮)，低效利尿剂(安体舒通、氨苯喋啶、)，低效利尿剂都有保钾的作用。利尿剂最大的优势是价格低廉。 β,阻滞剂 β,阻滞剂既能降低血压，又能减慢心率，应用很广泛。这是一类“洛尔”系列，常用的有阿替洛尔(氨酰心安)、美托洛尔(倍他乐克、美多心安)、拉贝洛尔(柳安苄心啶)、比索洛尔(博苏)。β,阻滞剂适用于年轻人和心率偏快的高血压病人，对合并冠心病的高血压病人尤为适合。但是，对心率已经很慢、存在心脏传导阻滞和有哮喘的高血压病人禁止服用。 α,阻滞剂 α,阻滞剂的特点是不影响血脂和血糖的代谢。这是一类“唑嗪”系列，常用的药物有短效的哌唑嗪，长效的多沙唑嗪、特拉唑嗪等。由于α,阻滞剂同时能治疗前列腺肥大，对伴有前列腺肥大的老年男性更为适用。α,阻滞剂主要的不良反应是会引起体位性低血压，所以，服用该药的病人，起床时要格外小心，动作要慢。 19 血管紧张素转换酶抑制剂 血管紧张素转换酶抑制剂是一类安全有效的降压药，它的种类最多，适应证最广，对血脂和血糖的代谢没有影响，对肾脏有保护作用，是高血压合并心力衰竭和糖尿病理想的首选药物。肾功能不好的病人也能应用，只是要从小剂量开始服用，严重的肾功能衰竭和患有双侧肾动脉狭窄的病人以及怀孕妇女则不能服用。令人遗憾的是，这么好的一类降压药却有咽痒干咳的不良反应，发生率在,,,左右，影响了药物的广泛应用。这是一类“普利”系列。根据药物作用时间的长短，可分为短效、中效和长效，短效的有卡托普利(巯甲丙脯酸)，中效的有依那普利(依那林)，长效的种类很多，有苯那普利(洛汀新)、培多普利(雅施达)、福辛普利(蒙诺)、贝那普利(一平苏)、米达普利(达爽)等等。 血管紧张素?受体拮抗剂 这是一类最新的降压药，是在血管紧张素转换酶抑制剂的基础上开发成功的。不会引起咽痒干咳的不良反应。被认为是不良反应最少的一类降压药，作为“沙坦”系列，最早应用的是氯沙坦，以后不断开发的有缬沙坦、依贝沙坦等。 钙拮抗剂 钙拮抗剂降压效果安全有效，其特点是在降压的同时，不降低重要器官的血液供应，对血脂、血糖的代谢没有影响，适用于老年高血压和已有心脑肾损害的高血压病人。此类“地平”系列种类不少。短效的有硝苯地平(心痛定)、恬尔心，中效的有尼群地平，长效的有氨氯地平(络活喜)、非洛地平(波依定)、尼卡地平。通过对制剂工艺的改进，制成缓释和控释片，使短效的药物具有长效的作用，如硝苯地平控释片(拜新同)、恬尔心缓释片、缓释异搏定(维拉帕米)。常见的不良反应有面红、头痛、心跳加快、脚踝水肿，短效药的不良反应更为显著些。 马志敏医师做客人民网谈高血压防治 人民网10月8日讯 今天是全国防治高血压日，健康频道邀请到同仁医院主治医师马志敏做客健康论坛，与网友就高血压的防治进行交流。 20 马医师介绍说，高血压是一种常见病，也是一个可能带来很严重临床后果的疾病，有人将它称为“无声的杀手”——高血压通常没有太特异的临床症状，容易被患者忽略，直到出现严重的靶器官损害时才开始接受治疗。流行病学调查资料显示，目前我国高血压的知晓率、治疗率、控制率都很低，因此需要广大医生、广大患者相互配合，更好地治疗高血压，减少高血压的危害。对高血压防治而言，正确的认识高血压，改善不良的生活方式，主动地配合医生接受抗高血压药物治疗，选用有效的药物，规律服药，是最重要的措施。 马医师在访谈重点中针对患者提出的普遍性问题进行解答，纠正了网友们普遍认为“服药有害”的观点，他说，高血压的控制对靶器官的保护十分重要，如果不按医生的处方定期服药，自行断药和换药，对心脑血管的保护都是不利的。访谈内容如下: 什么叫高血压,高血压的分类以及常见症状。 高血压的诊断标准也是有过一些变化，最近美国和欧洲都又修订了高血压指南，把高血压的标准定在收缩压超过140，舒张压超过90，血压超过水平就叫高血压。 高血压的分类从病因来讲，一个是原发性高血压，一个是继发性高血压，另外，根据血压水平来进行分级、分组，收缩压140—159、舒张压90—99叫做一级高血压，收缩压160—179、舒张压100—109叫二级高血压，收缩压超过180、舒张压超过110，叫三级高血压。 高血压的病人通常没有太特异的症状，很多高血压病人血压水平很高，但是自己没有任何不舒服的表现，所以高血压的病人不能根据有没有症状来决定自己是否需要吃药治疗或者是估计自己血压控制得好不好，而一定要测量血压，根据血压值来决定是否吃药或者如何调整药物。 高血压真的能治愈吗, 高血压是分为两类，一类叫原发性高血压，一类叫继发性高血压或者叫阵状性高血压，一般来讲，原发性高血压是指发病原因不明确的，这中高血压是不可能治愈的，只能用药物控制，尽量避免其对身体各个系统造成危害。有一部分继发性高血压是可以通过外科手术或者是用介入的方法得到有效的控制甚至治愈，比如原发性醛固醇增多症、嗜铬细胞瘤、肾动脉狭窄这几种情况，大多数高血压都是无法治愈的，只能长期用药物控制。 原发性和继发性血压表征有什么区别, 继发性高血压也叫症状性高血压，这种高血压是合并有其他疾病的，高血压只是这群疾病中的一个表现，比如像刚才说的三个原发性醛固醇增多症、嗜铬细胞瘤、肾动脉狭窄，本身都有这种疾病的特异性表现，像原发性醛固醇增多症，病人的发病年龄一般比较早，可能 21 有低血钾、全身乏力这些情况，血压水平一般比较高，容易出现眼底或者心脑血管系统的损害，大多数病人可能需要外科手术切除腺瘤来治疗。 喝酒、抽烟到底对高血压有什么影响, 根据目前已有的资料，吸烟肯定是高血压的一个危险因素，吸烟不仅可以使高血压的患病率增加，而且持续吸烟的高血压患者的血压也比不吸烟的患者更加难以控制，因此，建议所有的高血压患者都应该戒烟。酗酒肯定也是高血压的一个危险因素，但是少量饮酒可能有助于预防动脉粥样硬化性的疾病，一般来讲，每日的饮酒量照国际标准是不超过两个标准杯，大致相当于白酒1—2两，啤酒800毫升左右。 请马医生介绍一下哪类人群比较容易得高血压，有什么简单的预防措施，比如饮食上应该注意什么, 目前原发性高血压被认为是一种跟生活方式有密切关系的的疾病，不良的生活方式包括吸烟、酗酒、工作过于紧张、不爱活动，以及一些高盐、高脂饮食，还包括A型性格、糖尿病、有高血压家族史等其他一些危险因素，具有上述不良生活方式或者危险因素越多的人，发生高血压的可能性就越大。 高血压的预防主要就是从改善这些不良的生活方式入手，再就是合并糖尿病或者其他一 些高血压危险因素的病人，应该控制好糖尿病或者其他疾病，减少高血压发生的可能。 饮食上最重要的就是低盐、低脂、高纤维素，最近有一些健康讲座或者健康读物上介绍比较多的“红、黄、绿、白、黑”原则。 高血压是不是和心脏病及高胆固醇的摄入密切相关,作为患者应该怎样考虑这几方面的综合因素,应该如何引导患者注意这方面的问题,尤其是这几种病症都有的患者应该注意什么, 刚才讲到高血压是一种跟不良生活方式和一些危险因素有密切关系的疾病，像高胆固醇就是其中一种危险因素。另外，高血压对身体造成的危害也叫靶器官的损害，靶器官一般包括心脏、脑血管、肾脏和眼底，因此，刚才说的高血压确实和心脏疾病及高胆固醇这些因素都有密切关系。所以，高血压的治疗并不单纯是一个药物治疗，而应该是一个综合性的防治，包括改善不良生活方式、减少或者控制其他高血压危险因素，再加上药物治疗，预防靶器官的损害。 患者如何识别真正的有效药物, 降血压药物第一重要的就是降血压，药物否有效，可以通过监测用药后的血压水平而定。 22 目前世界卫生组织推荐的降压药物有六类:利尿剂、Beta阻滞剂、阿尔法阻滞剂、钙拮抗剂、血管紧张素转化酶抑制剂、血管紧张素II受体拮抗剂，在我国还普遍使用一些复方制剂，比如降压零号或者复方降压片，降血压应该首选这些药物。 年轻人从多少岁需要开始注意高血压，请指教～ 其实现在来讲，从儿童就应该开始预防，今年世界心脏日的活动主题就是“预防心脑血管病要从儿童开始”。去年美国制定的《高血压指南》里提出，人的正常血压应该是小于120—80毫米汞柱，超过120—130、80—85称为高血压前期，也就是说从这种水平的血压开始，就应该开始严格地改善不良生活方式，或者预防和避免各种高血压的危险因素，防止高血压的发生。 高血压吃药一段时间后，血压平稳了，能够停一段时间的药吗, 一般来讲，高血压的患者很可能需要终身服药，但是如果在药物治疗的情况下血压控制得很好，可以在医生的指导下逐渐减少药物的用量，但应该避免随意停药。 马医生能不能结合平日的治疗经验，给广大网友提些建议呢, 高血压是一个常见病，也是一个可能带来很严重临床后果的疾病，有人将它称为“无声的杀手”，是指高血压通常没有太特异的临床症状，容易被患者忽略，直到出现严重的靶器官损害时才开始接受治疗。流行病学调查资料显示，目前我国高血压的知晓率、治疗率、控制率都很低，因此需要广大医生、广大患者相互配合，更好地治疗高血压，减少高血压的危害。对高血压防治而言，正确的认识高血压，改善不良的生活方式，主动地配合医生接受抗高血压药物治疗，选用有效的药物，规律服药，是最重要的措施。 您好，我今年44岁，患高血压4年了，主要是舒张压高，一般在100mmhg左右，感觉自己年轻，不想按时吃药，又症状才吃，后来感觉布行(在家自己测量，经常处于高的状态)， 请问:高血压药物必须连续吃吗,必须经常更换药物嘛, 从您介绍的情况看，高血压的症状很明确，肯定需要药物治疗，有没有症状不是决定高血压是否治疗的依据，如果血压水平持续偏高的话，就需要接受药物治疗。抗高血压的药物在大多数病人都需要长期甚至是终身服用，如果是一种药物能很好地控制血压，又没有出现不可接受的副作用，不需要频繁地更换药物。 马医生，您好～我的婶婶今年80岁了，高压140，低压55，压差这么大该如何保健, 首先，从高血压的诊断标准讲，你说的情况还没有达到可以诊断高血压的水平，对老年人来说，压差在医学上也叫脉压，脉压大是一个老年人很常见的情况，主要的原因是因为老 23 年人动脉僵硬、糖性减低以后出现的情况，如果血压持续在140—55水平的话，不需要用特殊的药物。 嘉宾好，我在高校机关工作今年44岁，我母亲血压高，而我平时血压不高，工作紧张繁忙的时候就高，有时高至100-180，挺吓人的，但没有明显的感觉。最近白天血压高的时候，半夜偶尔发生头疼，不知道是怎么回事, 从目前这位网友介绍的情况看，高血压的诊断还不是很明确。诊断高血压需要有不在同一天测量的至少两次血压水平作为标准，并且测量血压之前要保证安静、情绪平稳，要休息5—10分钟以后测坐位右上肢的血压，这位网友讲的都是在工作紧张的时候血压才升高，所以用这个血压来诊断高血压不太可靠。建议这位网友应该加强血压的监测，在符合刚才讲的标准的情况下反复测量血压，如果在这种情况下测量的血压确实大于140—90毫米汞柱的话，就应该考虑是高血压。 高血压一天就吃一次药就可以了，可是我父亲一天吃三次药也不稳定，他以前得过糖尿病和肝炎，不过现在已经根除了，他现在吃的药是卡托普利和尼群地平片，请问，我父亲该吃什么药比较好, 在高血压的药物治疗上，目前主张用每天吃一次长效药物，优点是可以保证在24小时之内血压平稳地下降，没有太大的波动，这样可以减少靶器官的损害。您父亲现在吃的两种药都不是长效制剂，每天需要用药两到三次，如果有可能的话，可以改为长效制剂，比如和卡托普利同一类的福辛普利或西拉普利，或者是和尼群地平同一类的络活喜和拜欣同，当然具体用什么药，建议还是根据给您看病的医生的意见来确定。 高血压患者有没有水肿的现象出现, 高血压跟水肿一般来讲没有直接的关系，如果高血压患者发生水肿的话，应该想到几种可能:一种是抗高血压药物的副作用，包括钙拮抗剂、ACEI、ARB都有水肿的副作用。另外，长期高血压导致心脏或者肾脏损害，出现心衰、肾功能衰竭以后，也可能会出现水肿。具体原因建议这位网友到医院检查。 请问那种治疗高血压的药物不影响性功能。 到目前为止，哪一类抗高血压药物能明确地影响性功能还没有定论，一般认为Beta阻滞剂的可能性相对大一点，但不论是哪一类药物，都不会对性功能造成很明显的影响。因此，如果确实是高血压患者的话，应该接受药物治疗，暂时可以不用考虑对性功能的影响。 我的血压平躺时不高,坐起就高,(100-160左右),是怎么回事? 24 这种情况应该属于体位性高血压，是一种相对少见的情况，建议这位网友到医院作比较详细的检查，看有没有合并其他高血压的危险因素，或者有没有靶器官的损害，以决定是否 需要立即开始药物治疗。 我是一名高血压患者，我最近服的是《伲福达》，现在不知道这种药能否长期服用，能否早上服一片，晚上服其他降压药相配合用。 伲福达是一种长效的硝苯地平缓释片，也是一种有效的降压药物，如果不出现副作用的话，可以长期服用。一般来讲，需要每天两次。是否需要和别的药物合用，取决于血压水平和靶器官损害的情况。 有家族病史，现在37岁，总是吃药，血压也保持在140—100的状态，怎么办, 不知道现在这位网友都吃什么抗高血压的药物，如果是用了三种足量的抗高血压药物(包括利尿剂在内)，血压还未控制到理想的水平，称为顽固性高血压，不知道这位网友现在吃药的情况，所以不知是不是顽固性高血压。一般来讲，绝大部分高血压都能通过药物治疗得到比较满意的控制，建议这位网友接着再到医院就诊，调整降压药物的用法和剂量。 有位患者是五年前发现患的高血压，这几年都是每天服用一片“开博通”，但是最近发现心脏不定期疼痛，请问为什么吃药还不能控制病情，需要采用什么方法才能控制病情呢, 心脏不定期疼痛跟高血压没有直接关系，如果是中老年人出现心前区的疼痛，应该除外冠心病的可能，建议最好到医院检查。另外，“开博通”是短效药物，每天一片“开博通”，一般来讲，对降压治疗是不够的。 高血压病人的十大误区 高血压是一种高发病率、高并发症、高致残率的疾病，严重威胁着人们的健康和生活质量。很好地控制高血压，对减少和避免患者重要脏器的损害具有重要的意义。但是，不少病人对待治疗尚有不正确的认识和做法，因此影响了治疗效果。 一是以自我感觉来估计血压的高低。这样做往往不准确，特别是长期患高血压者，由于对高血压产生了“适应”性，所以即使血压明显升高，也无任何不适。如仅以自我感觉来决定是否服药，那样贻害无穷。正确的做法是，患者应主动定期测量血压，每周至少测量血压1次。 25 二是用药不规则。有些病人不能坚持服药，有时服药，有时又不服，导致血压不稳定，造成心、脑、肾等重要脏器长期受损。 三是血压一正常，即停药。这种不正确的服药方法，导致了血压出现升高—降低—升高的不稳定情况。这样不仅达不到治疗效果，而且由于血压出现较大幅度的起伏，将会引起心、脑、肾发生严重的并发症，如脑溢血等。正确的方法是，服药后出现血压下降，可采用维持量继续服药，或者在医生的指导下将药物进行调整，可以增减药物品种或服药剂量，而不应断然停药。 四是“盲目治疗”。有的患者长时间一味服药而不定期到医院检查，这样易产生药物副作用或耐药性。不同的病人需根据其病程、年龄、个体差异、脏器功能等情况，在医生指导下选择适当的药和适当的药量。 五是单纯依赖降压药，不做综合性治疗。高血压是由多种因素造成的，治疗上也需要采取综合性的措施，否则就不可能取得理想的治疗效果。在治疗过程中，除选择适当的药物外，还要注意劳逸结合，饮食宜清淡、少盐，适当地参加文体活动，减轻体重等。 六是认为降压药属于“顶药”，服不服药没有多大差别。在高血压的患者中，80,以上的患者均属于原发性高血压(原因不明的高血压)，必须用药物来控制血压，以减少和推迟脏器的损害，延长寿命。因此，正确的做法是，认清降低血压的意义，积极控制高血压。 七是盲目长期服用一种降压药，将服药作为一种“生活习惯”，不讲究实效。任何药物长期服用都会降低疗效，产生耐药性，并易出现药物副作用。此外，不同的病人，需根据其病程、年龄、个体差异、脏器功能等情况，选择适当的药物治疗，千篇一律或长期服用一类药物，不加更改，不明血压高低，实际上也是一种“盲目或无效治疗”，所以这种做法是不可取的。正确的做法是，在医生的指导下，按病情的需要及时调整药物。 八是不求医，自行购药治疗。这种做法实际上是将高血压的治疗简单化了。目前，市场上治疗高血压的药物多达几十种，各有适应症和一定的副作用，病人的情况也各不相同，科学地、合理地治疗，需在医生的指导下完成，自行购药服用，带有一定的危险性。 九是自认为血压只是偏高，不值得治疗。一般来说，成年人的血压超过140,85毫米汞柱，即可认为患有高血压。但部分早期高血压患者，血压处在上述的边缘状态，因此往往不被重视。事实说明，这种程度的高血压同样对机体会产生危害。正确的做法是除密切观察病情的发展外，还应给予包括药物在内的综合性治疗，当然选择何种药物是值得推敲的，如初期阶段，可先服用一些调解植物神经平衡的药物或利尿剂等。 26 十是不根据具体情况，一味追求血压达到正常水平。老年人(指60岁以上者)，均有不同程度的动脉硬化(主要指心、脑、肾)，稍偏高一点的血压，有利于脏器的血液供应，如果不顾年龄及病人的自身情况，而一味要求降压到正常水平，反而得不偿失。血压究竟降至多少为宜，应因人而宜，不可一律追求正常血压值。 控制血压勿陷误区 高血压病是一种与环境和多基因遗传因素相关的疾病。由于社会进步，生活水平提高，生活节奏加快，精神压力增加，高血压病在人们不经意间迅速增加。 近20年来高血压的发病率在我国几乎增加了一倍，由高血压引发的心脑血管疾病的死亡率已排到所有疾病死亡率的第一位。高血压病已成为威胁人类健康的一种严重疾病，但多数人对此还没有足够的认识。 临床上经常有一些老年人，血压已达到150,170/90,100mmHg，还说自己血压正常。很多人认为，老年人的血压可以比年轻人的高，这种观点是不对的。只要符合世界卫生组织和中华医学会的诊断标准，即不分年龄、不分男女，收缩压?140mmHg或舒张压?90mmHg，即可诊断为高血压病。 许多高血压病人在临床上并无症状，所以在高血压人群中只有44.7,的人知道自己患有高血压，而服药率仅有28.2,，血压控制率只有8.1,。高血压控制率低主要是由于人们在治疗上的错误认识造成的。一些人在血压控制后擅自停药或减量;盲目相信一些没有经过临床验证的中药;认为输液可以治疗高血压。输液治疗有时可以使血压降低，但它并不能治疗高血压病。 多数高血压病人需要终身服药，高血压药物治疗个体性很强，不同情况的病人应该选择不同的药物。坚持用药，保持健康的生活方式，高血压病是完全可以控制的。 (河南省洛阳市中心医院心内科 杨晓明) 高血压完全可以控制 27 出场专家:中国高血压防治指南学术委员会委员、北京协和医院特需医疗部顾问纪宝华教授。 高血压是心脑血管疾病的基础 记者:纪教授，现在高血压患者越来越多，您能介绍一下高血压的发病情况吗, 纪宝华:高血压作为心脑血管疾病的基础，发病率呈逐年上升的趋势。在我国，20世纪五六十年代高血压发病率不到5%，到了80年代超过7%，90年代超过11%，现在的发病率已超过25%。 记者:发生高血压的诱因是什么, 纪宝华:高血压是一种生活方式病，吸烟、饮酒、高盐、饮食不平衡都是发生高血压的危险因素，它往往不是单纯的血压高，而表现为一种综合征，高血压、高血脂、高血糖、肥胖、吸烟是5个相互关联的危险因素，其他的还有遗传因素和缺少运动等。危险因素越多，越易得心脑血管疾病。 记者:高血压有哪些症状，会造成哪些严重后果, 纪宝华:高血压是指动脉血压异常增高，患者初期常无明显症状。尽管有一些症状普遍认为与高血压有关，如头痛、头晕、面色潮红以及疲乏等，但同样的症状也常常发生在没有高血压的个体身上。高血压本身并不可怕，但随着病情加重，常常使周围靶器官，如心、脑、周围血管、肾等脏器受累，发生功能性或器质性改变，甚至致残致死，如心力衰竭、肾病、脑出血等。由于在出现致命性损害之前，通常很长时间没有任何症状，因此高血压常被称为“无声的杀手”。 90%的高血压没有明确病因 记者:血压超过多少才算高血压,是什么原因造成的, 纪宝华:由于各个国家和地区的医疗水平不同，其确定的高血压范围也不同，我国的标准是未服抗高血压药情况下，收缩压?140mmHg，或舒张压?90mmHg，视为高血压。引起血压升高的原因多为心脏泵血能力加强、大动脉失去弹性、循环中液体容量增加等。 记者:血压高了就是高血压吗, 纪宝华:诊断血压高不能仅依据血压值。首先，静坐或平卧后测得的血压?140/90mmHg，可以认为有血压增高，但不能依据单次测定的血压读数作出高血压的诊断。有时候，甚至有几次血压读数升高也不能诊断为高血压。如果一个人的初次血压读数增高，应该再重复测定一次，在随后两天内的不同时间至少再测定两次，以证明血压增高确实是持续存在。一定要 28 排除心理紧张，比如有一类“白大衣高血压”，平时正常，一看见穿白大衣的医生血压就高。 第二步是分辨高血压的类型。大约90%的高血压患者没有明确的原因存在，这种高血压称为“原发性高血压”。原发性高血压的发生可能为多种因素作用的结果。心脏和血管的多种改变同时存在，可能使血压升高。知道病因的高血压称为“继发性高血压”。5%—10%的高血压患者由肾脏疾病引起，1%—2%的高血压患者可能是体内激素异常或服用了某些药物而引起血压升高。 第三步是患者有无其他危险因素。血压的测定不仅能确定高血压的存在，而且能判断高血压的严重程度。对于伴有高血脂、高血糖、肥胖、吸烟、饮酒、家族史这些危险因素的人群来说，更要特别重视高血压。 诊断高血压的最后一步，需要检查高血压对重要脏器，特别是心、脑、血管、肾和眼底的影响。患者尿液的检测可以发现高血压造成肾脏损害的早期证据，如尿液中检出红细胞和白蛋白，可能提示存在肾脏损害。尽管只有大约10%左右的高血压患者可能发现病因，医生通常也要尽力去找寻，对年轻的高血压患者尤其重要。血压越高，患者越年轻，就更要寻找可能的病因。控制高血压，先改变生活方式 记者:纪教授，我们应该怎么预防和及早发现高血压呢, 纪宝华:美国的经验教训非常值得我们借鉴。美国专家提示我们，“只治不防，越治越忙”。及早治疗、控制，可以延长寿命。在高血压的危险因素中，除了遗传等不可干预性因素外，其他因素都可人为改变，特别是要改变不良的生活习惯。戒烟、戒酒;控制盐和糖的摄入量;加强体育锻炼，增强自身体质，如慢跑;控制饮食，防止过度肥胖，中国儿童的肥胖是不容忽视的。这些都需要进行公众教育，使人们从小就养成良好的生活习惯。今年全国防治高血压日的主题正说明了控制血压的关键在于保持健康生活方式。此外，我国北方地区的饮食是典型的高钠低钾饮食，如泡制的咸菜等，这也造成了我国北方地区的高血压发病率高于南方地区。 记者:高血压怎么治疗呢, 纪宝华:我们对于高血压的治疗就是控制血压值，使其降低至正常值或接近正常值，从而防止心脑血管疾病的发生，保证人们正常的生活水平。高血压的治疗包括非药物治疗和药物治疗。非药物治疗主要就是进行生活方式的干预。如果有高血压趋势的人没有其他危险因素，没有其他器官损伤，没有家族史，可能通过非药物治疗就能控制血压。超重的患者应将体重降到理想水平。改变饮食结构对于心血管系统健康相当重要。每日食盐的摄入量要低于 29 6克，同时要保证钙离子、镁离子和钾离子足够摄入;每日控制饮酒量;适当的有氧运动;吸烟者戒烟。 降压药都有副作用 记者:都有哪些药物可控制高血压, 纪宝华:任何高血压都能使用药物来控制血压，但治疗应该个体化。不同降压药物的降压机制不同，选择药物治疗常要考虑如下几个因素:年龄、性别、高血压的严重程度、是否存在其他问题(如糖尿病和高血脂)等。治疗过程中应监测药物的安全性。大多数人在治疗过程中没有任何不适。但应知道任何降压药都有一定的副作用。治疗高血压的药物主要包括下面六类: 一、利尿剂，有助于肾脏排出体内的钠盐和水分，降低血容量从而降低血压。利尿剂也能引起血管的扩张。 二、β阻滞剂，是一组能阻断交感神经系统作用的药物，适用于年轻人和发生过心梗或有快速性心律失常的患者，以及心绞痛或周期性偏头痛患者。 三、血管紧张素转换酶抑制剂，通过对动脉血管的扩张来降低血压，这类药物适用于年轻人、心力衰竭患者、由于慢性肾病或糖尿病性肾病导致的蛋白尿患者，以及服用其他药物出现较多副作用的患者。 四、血管紧张素?阻滞剂，通过与血管紧张素转换酶抑制剂相类似的机制产生降压作用，而且副作用较少。 五、钙拮抗剂，通过一种完全不同的机制使血管扩张，尤其适用于老年人和心绞痛患者、某些类型的快速心率或周期性偏头痛者。 六、α阻滞剂。 每种药物自身的药理作用、药物代谢动力学、药效及其副作用都是不相同的，在选用时候，应该扬长避短，根据不同的病情，选择剂量最低、益处最大、最适合的药物。 记者:继发性高血压怎么控制, 纪宝华:继发性高血压可以找到发病的原因，通过对症下药，可以使血压降低。如果是肾病引起的高血压，治疗肾病有可能使血压降到正常，至少能使血压下降，因此药物治疗通常有效。肾动脉狭窄患者可以通过介入治疗，如狭窄动脉的球囊成形术，使狭窄的血管扩张，或进行外科手术搭桥治疗血管狭窄。通常经过介入或手术治疗能治疗此种类型的高血压。此外，有些女性服用避孕药，造成继发性高血压，只要停止避孕药的服用，就可以使血压恢复 30 正常。但是，有些继发性高血压的病因是很难医治的，如慢性肾炎等，难以完全治愈，所以，在治疗病因的同时，还要用治疗原发性高血压的方法控制血压。 随意停药造成病情反复 记者:有些高血压患者用药后血压恢复正常，就随意停药，这样对不对,高血压患者应该怎么配合医生的治疗, 纪宝华:随意停药是不对的，因为目前高血压的致病机理还没有得到明确的解释。有些药物在连续使用一个月后才能见效，如果患者在用药过程中，只用了一两个星期，发现没有效果，就随意停药，或换医生重新开药，容易增加副作用，而且难见疗效。也有些患者用药后，取得了一定的疗效，认为病情已经稳定、康复，而自行停药，这种做法也是不对的。我们日常接触的患者中，大部分都不能完全按医生的医嘱执行，随意停药，造成病情反反复复，容易造成严重后果的。患者在用药过程中，如果有不适或好转等情况，应及时与医生联系，修改治疗方案，从而达到最好的治疗效果。总之，患者急于控制血压或满不在乎的态度都不利于治疗，而通过正确的治疗，高血压完全可以控制，不会进一步诱发心脑血管疾病。 《健康时报》 31 (英文版 ) Two regulations promulgated for implementation is in the party in power for a long time and the rule of law conditions, the implementation of comprehensive strictly strategic plan, implementation in accordance with the rules and discipline to manage the party, strengthen inner-party supervision of major initiatives. The two regulations supporting each other, the < code > adhere to a positive advocate, focusing on morality is of Party members and Party leading cadres can see, enough to get a high standard; < rule > around the party discipline, disciplinary ruler requirements, listed as "negative list, focusing on vertical gauge, draw the party organizations and Party members do not touch the" bottom line ". Here, the main from four square face two party rules of interpretation: the first part introduces two party Revised regulations the necessity and the revision process; the second part is the interpretation of the two fundamental principles of the revision of laws and regulations in the party; the third part introduces two party regulations modified the main changes and needs to grasp several key problems; the fourth part on how to grasp the implementation of the two regulations of the party. < code > and < Regulations > revised the necessity and revised history of the CPC Central Committee the amendment to the Chinese Communist Party members and leading cadres honest politics several guidelines > and < Chinese Communist Party discipline and Punishment Regulations > column 1 by 2015 to strengthen 32 party laws and regulations focus. Two party regulations revision work lasted a Years, pooling the wisdom of the whole party, ideological consensus, draw historical experience, respect for the wisdom of our predecessors, which reflects the unity of inheritance and innovation; follow the correct direction, grasp the limited goals, adhere to the party's leadership, to solve the masses of the people reflect a focus on the problem. The new revision of the < code > and < rule >, reflects the party's 18 and the eighth session of the third, the spirit of the fourth plenary session, reflecting the experience of studying and implementing the General Secretary Xi Jinping series of important speech, reflects the party's eighteen years comprehensive strictly practice. (a) revised two regulations of the party need of < the ICAC guidelines > in < in 1997 Leaders as members of the Communist Party of China clean politics certain criteria (Trial) > based on revised, the promulgation and implementation of January 2010, to strengthen the construction of the contingent of leading cadres play an important role. But with the party to manage the party strictly administering the deepening, has not been able to fully meet the actual needs. Content is too complicated, "eight prohibition, 52 are not allowed to" hard to remember, and also difficult to put into practice; the second is concisely positive advocated by the lack of prohibited provisions excessive, no autonomy requirements; the third is banned terms and discipline law, both with the party discipline, disciplinary regulations 33 repeat and Criminal law and other laws and regulations repeat; the fourth is to "clean" the theme is not prominent, not for the existing problems, and is narrow, only needle of county-level leading cadres above. < rule > is in 1997 < Chinese Communist Party disciplinary cases (Trial) > based on revision, in December 2003 the promulgation and implementation, to strengthen the construction of the party play very important role. Along with the development of the situation, which many provisions have been unable to fully meet the comprehensive strictly administering the practice needs. One is Ji law, more than half of the provisions and criminal law and other countries laws and regulations Repetition; two is the political discipline regulations is not prominent, not specific, for violation of the party constitution, damage the authority of Party Constitution of misconduct lack necessary and serious responsibility to pursue; third is the main discipline for the leading cadres, does not cover all Party members. Based on the above situation, need to < the criterion of a clean and honest administration > and < rule > the two is likely to be more relevant regulations first amendment. By revising, really put the authority of Party discipline, the seriousness in the party tree and call up the majority of Party members and cadres of the party constitution of party compasses party consciousness. (II) two party regulations revision process the Central Committee of the Communist Party of China attaches great importance to two regulations revision . Xi Jinping, general books recorded in the Fifth 34 Plenary Session of the eighth session of the Central Commission for Discipline Inspection, on the revised regulations < > made clear instructions. According to the central deployment, the Central Commission for Discipline Inspection from 2014 under six months begin study two regulations revision. The Standing Committee of the Central Commission for Discipline Inspection 4 review revised. Comrade Wang Qishan 14 times held a special meeting to study two regulations revision, amendment clarifies the direction, major issues of principle, path and target, respectively held a forum will listen to part of the province (area) secretary of the Party committee, Secretary of the Discipline Inspection Commission, part of the central ministries and state organs Department The first party committee is mainly responsible for people, views of experts and scholars and grassroots party organizations and Party members. Approved by the Central Committee of the Communist Party of China, on 7 September 2015, the general office of the Central Committee of the Party issued a notice to solicit the provinces (autonomous regions, municipalities) Party, the central ministries and commissions, state ministries and commissions of the Party (party), the General Political Department of the military, every 3 people organization of Party of two regulations revision opinion. Central Commission for Discipline Inspection of extensive solicitation of opinions, careful study, attracting, formed a revised sent reviewers. In October 8 and October 12, Central Committee Political 35 Bureau Standing Committee and the Political Bureau of the Central Committee After consideration of the two regulations revised draft. On October 18, the Central Committee of the Communist Party of China formally issued two regulations. Can say, two laws amendment concentrated the wisdom of the whole party, embodies the party. Second, < code > and < Regulations > revision of the basic principles of two party regulations revision work and implement the party's eighteen, ten eight plenary, the spirit of the Fourth Plenary Session of the Eleventh Central Committee and General Secretary Xi Jinping important instructions on the revised < low political criterion > and < Regulations >, highlighting the ruling party characteristics, serious discipline, the discipline quite in front of the law, based on the current, a long-term, advance as a whole, with Bu Xiuding independent < rule > and < rule >. Main principle is: first, adhere to the party constitution to follow. The constitution about discipline and self-discipline required specific, awaken the party constitution of party compasses party consciousness, maintaining the authority of the constitution. General Secretary Xi Jinping pointed out that "no rules, no side round. Party constitution is the fundamental law, the party must follow the general rules. In early 2015 held the eighth session of the Central Commission for Discipline Inspection Fifth Plenary Session of the 16th Central Committee, Xi Jinping again pointed out that constitution is the party must follow the general rules, but also the general rules." the revision 36 of the < code > and < rule > is Method in adhere to the regulations established for the purpose of combining rule of virtue is to adhere to the party constitution as a fundamental to follow, the constitution authority set up, wake up the party constitution and party rules the sense of discipline, the party constitution about discipline and self-discipline specific requirements. 4 second is to adhere to in accordance with the regulations governing the party and the party. The Party of rule of virtue "de", mainly refers to the party's ideals and beliefs, excellent traditional style. The revised the < code > closely linked to the "self-discipline", insisting on the positive initiative, for all members, highlight the "vital few", emphasized self-discipline, focusing on the morality, and the majority of Party members and the ideological and moral standards. The revised < > Ji method separately, Ji, Ji Yan to Method, as a "negative list", emphasizing the heteronomy, focusing on vertical gauge. Is this one high and one low, a positive reaction, the strict party discipline and practice results transformation for the integration of the whole party to observe moral and discipline requirements, for the majority of Party members and cadres provides benchmarking and ruler. Third, insist on to. In view of the problems existing in the party at the present stage, the main problems of Party members and cadres in the aspect of self-discipline and abide by the discipline to make clearly defined, especially the party's eighteen years strict political discipline and political rules, organization and discipline and 37 to implement the central eight provisions of the spirit against the four winds and other requirements into Disciplinary provisions. Not one pace reachs the designated position, focusing on in line with reality, pragmatic and effective. After the revision of major changes, major changes in the < code > and < rule > modified and needs to grasp several key problems (a) < code > < code > adhere to according to regulations governing the party and party with morals in combination, for at the present stage, the leadership of the party members and cadres and Party members in existing main problems of self-discipline, put forward principles, requirements and specifications, showing Communists noble moral pursuit, reflected at all times and in all over the world ethics from high from low 5 common requirements. One is closely linked to the "self-discipline", removal and no direct relation to the provisions of . the second is adhere to a positive advocate, "eight prohibition" 52 are not allowed to "about the content of the" negative list moved into synchronization amendment < cases >. Three is for all the party members, will apply object from the leadership of the party members and cadres to expand to all Party members, fully embodies the comprehensive strictly required. The fourth is prominent key minority, seize the leadership of the party members and cadres is the key, and put forward higher requirements than the ordinary Party members. Five is to simplify, and strive to achieve concise, easy to understand, easy to remember. The revised < code > is the ruling Party since the first insists on 38 a positive advocate forAll Party members and the self-discipline norms, moral declaration issued to all members of the party and the National People's solemn commitment. > < criterion of a clean and honest administration consists of 4 parts, 18, more than 3600 words. After the revision of the < code >, a total of eight, 281 words, including lead, specification and Party member cadre clean fingered self-discipline norms, etc. Part 3 members low-cost clean and self-discipline, the main contents can be summarized as "four must" "eight code". Lead part, reiterated on ideal and faith, fundamental purpose, the fine traditions and work style, noble sentiments, such as "four must" the principle of requirements, strong tone of self-discipline, The higher request for 6 and supervised tenet, the foothold in permanent Bao the party's advanced nature and purity, to reflect the revised standards requirements. Members of self-discipline norms around the party members how to correctly treat and deal with the "public and private", "cheap and rot" thrifty and extravagance "bitter music", put forward the "four norms". Party leader cadre clean fingered self-discipline norms for the leadership of the party members and cadres of the "vital few", around the "clean politics", from civil servant of the color, the exercise of power, moral integrity, a good family tradition and other aspects of the leadership of the party members and cadres of the "four norms" < > < norm norm. "The Party member's self-discipline norms" and "party members and leading cadre clean fingered self-discipline norms," a 39 total of eight, collectively referred to as the "eight". "Four must" and "eight" of the content from the party constitution and Party's several generation of leaders, especially Xi Jinping, general secretary of the important discussion, refer to the "three discipline and eight points for attention" statements, and reference some embody the Chinese nation excellent traditional culture essence of epigrams. (2) the revised regulations, the main changes in the revised Regulations > to fully adapt to the strictly requirements, reflects the according to the regulations governing the law of recognition of deepening, the realization of the discipline construction and Jin Ju. < rule > is party a ruler, members of the basic line and follow. And the majority of Party members and cadres of Party organizations at all levels should adhere to the bottom line of thinking, fear discipline, hold the bottom line, as a preventive measure, to keep the party's advanced nature and purity. 1, respect for the constitution, refinement and discipline. Revised < rule > from comprehensive comb physical constitution began, the party constitution and other regulations of the Party of Party organizations and Party discipline requirements refinement, clearly defined in violation of the party constitution will be in accordance with regulations to give the corresponding disciplinary action. The original 10 categories of misconduct, integration specification for political discipline, discipline, honesty and discipline masses Ji Law and discipline and discipline and other six categories, the content of < rule > 40 real return to Party discipline, for the majority of Party members and listed a "negative list. 7 2, highlighting the political discipline and political rules. > < Regulations according to the stage of the discipline of outstanding performance, emphasizing political discipline and political rules, organization and discipline, in opposition to the party's leadership and the party's basic theory, basic line, basic program and basic experience, the basic requirement of behavior made prescribed punishment, increase the cliques, against the organization such as violation of the provisions, to ensure that the central government decrees and the Party of centralized and unified. 3, adhere to strict discipline in the law and discipline In front, Ji separated. Revised < Regulations > adhere to the problem oriented, do Ji separated. Any national law existing content, will not repeat the provisions, the total removal of 79 and criminal law, repeat the content of the public security management punishment law, and other laws and regulations. In the general reiterated that party organizations and Party members must conscientiously accept the party's discipline, die van comply with national laws and regulations; at the same time, to investigate violations of Party members and even criminal behavior of Party discipline and responsibility, > < Regulations distinguish five different conditions, with special provisions were made provisions, so as to realize the connection of Party discipline and state law. 4, reflect Wind building and anti-corruption struggle of the latest achievements. < rule > the party's eighteen years 41 implement the spirit of the central provisions of the eight, against the requirements of the "four winds" and transformation for disciplinary provisions, reflecting the style construction is always on the road, not a gust of wind. In the fight against corruption out of new problems, increase the trading rights, the use of authority relatives profit and other disciplinary terms. Prominent discipline of the masses, the new against the interests of the masses and ignore the demands of the masses and other disciplinary terms and make provisions of the disposition and the destruction of the party's close ties with the masses. Discipline to protect the party's purpose. 8 of these regulations, a total of three series, Chapter 15, 178, more than 24000 words, after the revision of the regulations a total of 3 series, Chapter 11, 133, 17000 words, divided into "general" and "special provisions" and "Supplementary Provisions" Part 3. Among them, add, delete, modify the provisions of the proportion of up to nearly 90%. 1, the general general is divided into five chapters. The first chapter to the regulations of the guiding ideology, principles and scope of application of the provisions, highlight the strengthening of the party constitution consciousness, maintenance the authority of Party Constitution, increase the party organizations and Party members must abide by the party constitution, Yan Centralized centralized, would examine at all levels of the amended provisions implementing and maintaining Party discipline, and consciously accept the party discipline, 42 exemplary compliance with national laws and regulations. The second chapter of discipline concept, disciplinary action types and effects of the regulations, will be a serious warning from the original a year for a year and a half; increase the Party Congress representative, by leaving the party above (including leave probation) punishment, the party organization should be terminated its representative qualification provisions. The third chapter of the disciplinary rules of use prescribed in the discipline rectifying process, non convergence, not close hand classified as severely or heavier punishment. "Discipline straighten "At least eighteen years of five years, these five years is to pay close attention to the provisions of the central eight implementation and anti -" four winds ". The fourth chapter on suspicion of illegal party disciplinary distinguish five different conditions, with special provisions were made provisions, to achieve effective convergence of Party and country 9 method. < rule > the provisions of Article 27, Party organizations in the disciplinary review found that party members have committed embezzlement, bribery, dereliction of duty dereliction of duty and other criminal law act is suspected of committing a crime shall give cancel party posts, probation or expelled from the party. The second is < Regulations > Article 28 the provisions of Party organizations in the disciplinary review But found that party members are stipulated in the criminal law, although not involved in a crime shall be investigated for Party discipline and responsibility should 43 be depending on the specific circumstances shall be given a warning until expelled punishment. This situation and a difference is that the former regulation behavior has been suspected of a crime, the feeling is quite strict, and the latter for the behavior not involving crime, only the objective performance of the provisions of the criminal code of behavior, but the plot is a crime to slightly. < Regulations > the 29 provisions, Party organizations in the discipline review found that party members and other illegal behavior, affect the party's image, the damage to the party, the state and the people's interests, we should depend on the situation Seriousness given disciplinary action. The loss of Party members, seriously damaging the party's image of behavior, should be given expelled from the party. At this article is party member is in violation of the criminal law outside the other illegal acts, such as violates the public security administration punishment law, customs law, financial laws and regulations behavior. The fourth is < cases > Article 32 stipulates, minor party members and the circumstances of the crime, the people's Procuratorate shall make a decision not to initiate a prosecution, or the people's court shall make a conviction and exempted from criminal punishment shall be given within the party is removed from his post, probation or expelled from the party. Party members and crime, sheets were fined in accordance with For acts; the principal Ordinance amended the provisions of the preceding paragraph. This is the new content, in order to achieve Ji method effective 44 convergence. Five is < > the thirty third article 10 of the provisions, the Party member due to an intentional crime is sentenced to criminal law (including probation) sheets or additional deprivation of political rights; due to negligence crime and was sentenced to three years or more (excluding three years) a penalty, shall give expelled punishment. Due to negligence crime is convicted and sentenced to three years (including three years) in prison or be sentenced to public surveillance, detention, shall in general be expelled from the party. For the individual may not be expelled from the party, should control Approval. This is followed and retained the original > < Regulations the provisions of punishment party authorization rules and report to a level party organizations. For is "party members with criminal acts, and by the criminal punishment, generally should be expelled from the party". The fifth chapter of probationary Party member of the discipline and discipline after missing members of the treatment and punishment decisions, such as the implementation of the provisions, clear the related party discipline and punishment decision made after, for duties, wages and other relevant alteration formalities for the longest time. 2, sub sub section will the original regulations of 10 categories of acts of violation of discipline integration revised into 6 categories, respectively, in violation of the punishments for acts of political discipline "in violation of discipline behavior of punishment" in violation of integrity of disciplinary action points "of violation punishments for acts 45 of mass discipline" "the violation of work discipline, punishment" in violation of discipline of life behavior punishment "6 chapters. 3, annex" Supplementary Provisions "clear authority making supplementary provisions of, cases of interpretative organ, as well as regulations implementation time and retroactivity etc.. 11 (3) learning understanding > < regulations needs to grasp several key problems The first problem -- about the violation of political discipline behavior > < new ordinance chapter 6 the political discipline column for the six disciplines, that is the main opposition to Party leadership and the opposition of the basic theory, basic line, basic program and basic experience, basic requirements of misconduct made provisions of the disposition, especially the eighteen since the CPC Central Committee put forward the Yan Mingzheng treatment of discipline and political rules requirements and practical achievements transformation for Discipline article, increase the false debate central policies, cliques, against the organization review, make no discipline of the principle of harmony terms. These are the party's eighteen years in comprehensive strictly Process combined with the practice of rich content. (1) false debate the central policies and undermine the Party of centralized and unified the problem is made in accordance with the provisions of the party constitution. Constitution in general programme requirements adhere to democratic centralism is one of the requirements of the construction of the party must adhere to the four cardinal. Application 46 of this principle is not only the party the basic organization principle and is also the mass line in party life, it requires that we must fully develop inner-party democracy, respect for the dominant position of Party members, safeguarding the Party member democratic rights, give full play to the enthusiasm and creativity of the party organizations at all levels and Party members, at the same time, also must implement the right concentration, ensure the party's mission < the chaos in unity and concerted action to ensure that the party's decision to get quickly and effectively implementing. The Party Central Committee formulated the major principles and policies, through different channels and ways, fully listen to the party organizations and Party members of the opinions and suggestions, but 12 is some people face to face not to say back blather "" will not say, after the meeting said, "" Taiwan does not say, and nonsense ", in fact, not only disrupt the people thought, some causing serious consequences, the damage to the Party of the centralized and unified, hinder the central policy implementation, but also a serious violation of the democratic system of principles. There is no doubt that shall, in accordance with the Regulations > 4 Specified in Article 6 to give the appropriate punishment. For did not cause serious consequences, to give criticism and education or the corresponding tissue processing. (2) about the destruction of the party's unity < New Regulations > the forty eighth to fifty second article, to damage Party's unity unified and violation of political discipline, punishment situation 47 made explicit provisions. Article 52 of the new "in the party get round group, gangs seek private gain, cliques, cultivate private forces or through the exchange of interests, for their own to create momentum and other activities to gain political capital, given a serious warning or withdraw from their party posts disposition; if the circumstances are serious, to give Leave a party to observation or expelled from the party. (3) on against the organization review of the provisions of the constitution, party loyalty honesty is party members must comply with the obligations. Members must obey the organization decision, shall not violate the organization decided encounters by asking questions to find organization, rely on the organization, shall not deceive the organization, against the organization. For example, after the investigation does not take the initiative to explain the situation, but to engage in offensive and defensive alliance, hiding the stolen money is against survey organization, is a violation of the behavior of political discipline. Article 24 of the original > < Regulations, although the provisions of the interference, hinder group review the behavior of the fabric can be severely or 13 Aggravated punishment, but did not put this kind of behavior alone as a discipline for qualitative amount of discipline. > < new regulations increase the Article 57, "anti organization review, one of the following acts, given a warning or serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, give 48 expelled from the party: (a) on supply or forged, destroyed, transfer, conceal evidence; (II) to prevent others expose, providing evidence Material; (III) harboring co personnel; (4) to the organization to provide false information, to hide the fact; (5) the him against the acts of the organization review. "< rule > add this clause to the Constitution requires more specific, the previous no punishment in accordance with the definite list and put forward clear punishment in accordance with. (4) about organizing or participating in superstitious activities as < Regulations > about engage in activities of feudal superstition obstruction of social management order" violations of Article 164 the provisions, but according to the original < rule > only in disrupting production, work, social life order The case to be disciplinary treatment, in other words, alone make the feudal superstition, organize or participate in the activities of feudal superstition of, does not constitute a violation. Which is not consistent with the requirements of our party's political party. > < new regulations in this change is, superstitious activities on the political discipline, increase the Article 58, is the organization of Party members, in superstitious activities included in violation of the negative list of political discipline deserves punishment, which and Party members should adhere to the correct political principle, political standpoint and viewpoint is consistent. 14 the second question about organization and discipline violation behavior of democratic centralism is our The party's fundamental 49 organizational system. < New Regulations > Chapter 7 "in violation of the behavior of organizational discipline punishment" mainly for violation of democratic centralism, contrary to the "four obey the discipline behavior for source classification rules. Increased not in accordance with the relevant provisions or requirements to the organization for instructions to report on major issues; do not report truthfully report about personal matters; falsify personal archives; hide before joining the party serious mistakes; leading cadres in violation of the relevant provisions of the organization, will participate in the spontaneous formation of the old Xiang, Alumni Association, comrades in arms; to obtain illegal country residence abroad or foreign nationality, illegal for private frontier Documents such as discipline terms. (1) on the report truthfully report personal matters in 2010 the Central Committee of the Communist Party of China office, office of the State Council introduced < provisions on issues related to the leading cadres to report personal >, is clear about the request, deputy division level and above leading cadres should truthfully report changes in my marriage and spouse, children, moved to the country (territory), practitioners, income, real estate, investment and other matters, for failing to report, do not report, concealed and unreported, according to the seriousness of the case, giving criticism and education, and to make a correction within a time limit, shall be ordered to make a check, the commandment Jiemian conversation, informed criticism or jobs, free Post 50 processing, constitute violations, in accordance with the relevant provisions shall be given a disciplinary sanction. But since the original < Regulations > and there is no corresponding specific terms, the violation of the regulations, do not report, as a false report about personal matters, there is no corresponding disciplinary action terms, in practice it is difficult to operate. In this regard, in order to solve is not reported, as a false report about personal matters 15 asked censure, the new < Regulations > add the Article 67 of violation of personal matters related to reporting requirements, report truthfully report the clear punishment basis, making this kind of violation behavior is no longer free drilling for Exhibition on matters of personal checks to verify and supervision of cadres, discipline review provides a powerful discipline guarantee. (2) about the illegal organization, to fellow, alumni, friends of the war will < regulations stipulated in Article 68 of >, leading cadres of the party in violation of relevant provisions of the organization, will participate in the spontaneous formation of fellow, Alumni Association, comrade in arms to give the punishment according to the seriousness of the case. Here special needs note is three points: this provision for only the leading cadres ", reflecting the high requirements of leading cadres; second violation in 2002, the Central Commission for Discipline Inspection, the central Organization Department and the The relevant provisions of the General Political Department jointly issued the < off in leading cadres not to participate in 51 the initiative to set up "the villagers would be" alumni "" comrades in arms organization notice >. That is to say, to the spontaneous formation of fellow, Alumni Association, comrades in arms will constitute the premise of discipline is a violation of the provisions of this. The notification specified, leading cadres are not allowed to participate in the spontaneous incorporation of fellow, alumni, between comrades association would like the organization and shall not bear the sorority Human and the organizer shall not hold the corresponding position in the sorority; shall not borrow machine woven "network" and engage in kiss sparsely, round and round the gangs, but not "align" "Jieyi Gold Orchid" behavior. The third is to emphasize here that shall be organized to participate in the initiative to set up the villager, Alumni Association, comrades in arms. The so-called 16 spontaneous was established mainly means without registration. Therefore, Party members include leading cadres in the normal range of fellow, alumni, comrades in the party is not a violation of the rules of Party discipline. The three problem about integrity violations discipline Lian Jie discipline has been eighteen years clean government and anti The focus of the work of corruption. This Ordinance to amend, honesty and discipline this biggest adjustment, the new content, most of which prescribed by the original < criterion of a clean and honest administration > 8 ban and 52 are not allowed into the basic this part. (1) the central eight provisions of the spirit and requirements into < New > in 52 the regulations of the party's eighteen years, central resolutely implement the provisions of the eight and pay close attention to the node and intensive briefing, on public funds, private bus, public funds tourism, gifts of public funds, the big parade and lavish weddings and festive, illegal payment allowances and subsidies, illegal construction of buildings such as the original masses reflects the relatively strong, "four winds" problem of the Resolute rectification. But original < Regulations > to eat and drink, super standard reception and no clear and specific expression, new < rule > will implement eight Central provisions of the spirit of the problem increased to "clean cheap self-discipline" chapter, clear to exceed the standard, beyond the scope of the reception or borrow machine eating and drinking etc. some in violation of the provisions of the spirit of the eight central relevant persons responsible for punishment, once the violation will be according to the < rule > severely punished, binding, enhanced significantly. One is to add Article 87, about to obtain illegal, hold, and the actual use of the sports card, golf ball cards and other consumer card. Illegal access to private clubs made the punishment provisions. The second is increase the Article 97, has made provisions of the disposition of illegal self pay or 17 spamming allowances, subsidies and bonuses. The third is added to the Article 99, on violation of super standard, beyond the scope of the reception or borrow machine eat and drink to make the provisions of punishment. The fourth is to increase the Article 101, on the management 53 of conference activities in violation of the provisions made sanctions regulations. The fifth is the increased Article 102, for violation of office space management provisions made the punishment provisions. Six is to split the original < rule > Article 78, formed article 98, Article 100 of public Models of tourism, violate the provisions on the administration of the use of discipline of the bus through the list of made a more detailed provisions, apply more operational. Seven is increased the article 96, in violation of the relevant provisions of the, to participate in public funds to pay for dinner, high consumption of entertainment, fitness activities and public funds to buy gift, send gifts to make the provisions of the disposition. On the violation of the central provisions of the spirit of the eight, in addition to > < new regulations into "violation of honesty and self-discipline" misconduct outside, is different with the original < Regulations >, revised < rule > clearly defined not only to disposition of the directly responsible persons, but also dispose of collar Guide responsibilities. (2) increased trading rights, use of authority or position influence as relatives and close to profit violation of the terms of the < New Regulations > absorption < clean politics several guidelines > the relevant provisions spirit, increase the "negative list, including trading rights, the functions and powers or duties of influence as relatives and staff around profit. Increase Article 81" mutual use of office or authority ring for each other and their spouses, children and their spouses and other relatives, 54 around 18 personnel and other specific relationship between the people to seek benefits engage in trading rights, given a warning or serious warning Sanctions; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, shall be expelled from the party. Increase Article 82 "connivance, acquiescence to the spouse, children and spouse etc. relatives and staff around the effect of Party members and cadres personal authority or position for personal gain, if the circumstances are relatively minor, given a warning or a serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, the given Expelled from the party. Party members and cadres of the spouses, children and their spouses does the actual work and get salary or although the actual work but to receive significantly beyond the same rank salary standard, Party members and cadres informed fails to correct, in accordance with the provisions of the preceding paragraph. "(3) about the gifts, gifts misconduct from handling practices in recent years, engaged in official cadres received gifts, gifts problems more prominent. This has seriously affected the image of Party members and cadres, damaged the relations between the party and the masses, and is a hotbed of corruption, is really necessary for this kind of behavior to be disciplined. < rule > no on accepting gifts, gifts, Card consumption behavior to engage in simple "one 55 size fits all", but the difference between the different separately. One is in accordance with the provisions of Article 83, accepting may affect the impartial enforcement of the official gifts, gifts, consumer cards to depending on the seriousness of the case shall be given disciplinary sanctions. That is to say, for may affect the fair execution of business gifts, gifts, consumer cards are not allowed to accept. 19 is in accordance with the provisions of Article 83, accepting was significantly higher than normal ceremony is still exchanges of gifts, gifts, consumer card to disciplinary action. This is new regulations that daily life is purely reciprocity, accepting the same thing, boys , fellow friends gifts, gifts, shopping cards, although and fair execution of business has nothing to do, also want to as the case shall be dealt with, the situation is obviously beyond normal reciprocity ". The so-called" reciprocity ", one is emphasizes the reciprocal in protocol. In other words is you to me how, I to you how, not only does not go. The second is to significantly exceeded the normal local economy level, customs and habits, economic capacity of individual gifts, gift value. Specific sanctions to according to the processing of a variety of factors to consider, as appropriate. The third is the root according to the provisions of Article 84," to Engaged in public service personnel and their spouses and children, children's spouses and other relatives and other specific relationship presented Ming Xianchao normal reciprocity of gifts, gifts, consumer card, if the circumstances are 56 relatively serious, given a warning until probation. "In accordance with the above provisions, gift giving significantly beyond the normal reciprocity, giver constitute the discipline. (4) on illegal trading of stocks or of other regulations of securities investment < > Article 88 is engaged in punishment regulation of camp and activity in violation of the relevant provisions on. Among them, 3 will" buying and selling stocks or in other securities investment "column as one of disciplinary cases Out. First need to be clear, > < regulations did not change the provisions of the Ordinance. The ordinance of the provisions of the second paragraph of Article 77 provisions "who, in violation of the provisions of the sale of stocks" is one of the violation, and at the beginning of the first paragraph of this article "violation of 20 against the relevant provisions of the" textual representation of the repeat revision. In, just from the legislative technique removed the "personal" in violation of the provisions, content and not to change the original provisions. Need to clear is, "buy or sell a stock or of other securities investment" refers to violation of the relevant provisions refers to in April 2001, the Party Central Committee, the State Council promulgated the On the work of the party and government organs staff's personal investment in securities if dry provisions >. According to the provisions of Article 3, use of work time, office facilities, the sale of stocks and securities investment fund belongs to illegal behavior. The fourth question, about the violation of the masses of the disciplinary actions < 57 new regulations > would violate public discipline behavior of a single set of a class of restored "three rules of discipline and eight note" in the discipline of the masses of excellent traditional. < New Regulations > Chapter 9 "to violate the masses of disciplinary action", mainly the destruction of the party's close ties with the masses of misconduct made provisions on disciplinary; enrich and perfect the super standard, beyond the scope of Xiang Qun < All to raise fund and labor, in for involving the public affairs deliberately, chinakayao, in social security, policy support, disaster relief funds and materials and other matters assigned any kind and affectionate friends, obviously unfair acts against the interests of the masses of the disciplinary terms; increase the terms not in accordance with the provisions of the public party provided, government, factory and village (neighborhood) provided etc. violation of the people's right to know the behavior of the discipline. The fifth issue, on the violation of work discipline violation of work discipline added "negative list, including Party organizations carry out strictly Main responsibility for poor discipline terms. (1) the new party organization comprehensive strictly the main responsibility of the party does not fulfill the 21 or perform poor disciplinary terms < New Regulations > has a lead people to pay attention to the new terms, that is, in chapter ten "on the violation of work discipline behavior punishment" increase in the one hundred and fourteenth "party fail to perform 58 comprehensive strictly the main responsibility of the party or to perform comprehensive strictly the main responsibility for administering the ineffective, resulting in serious damage or serious adverse effects, to the person directly responsible and the responsibility of leadership and give a warning or serious warning. The situation is serious, giving removed from their party posts or on probation Punishment. "Here the changes. For the first time, the main responsibility write < rule >. (2) new shall report does not report or false reporting discipline shall increase the 117 bar" in the higher level units to check to inspect the work or report to the parent unit, work report of shall report the matters do not report or do not report, cause serious damage or serious adverse effects of, to the person directly responsible and the responsibility of leadership, to give warning or a serious warning; if the circumstances are serious, giving removed from their party posts or placed on probation. "For example, during the tour visits to the region, the unit Members the obligation to the inspection teams to reflect the true situation, to conceal not reported or intentionally to the inspection teams to provide false information, causing serious damage or serious adverse effects of, the person directly responsible and the responsibility of leadership should be in accordance with the provisions of < rule > Article 117 to give the appropriate punishment. (3) the new not granted in accordance with the provisions of punishment, not according to the provisions of the implementation of disciplinary measures 22 violation 59 of the provisions of Article 115 "Party organizations have one of the following circumstances, the direct leadership responsibility. Probation: members were sentenced punished, in accordance with the provisions give disciplinary action or in violation of state law Rules of behavior should be given disciplinary punishment and dispose of; disciplinary punishment by decision or complaint review the decision made, not in accordance with the provisions of the implementation decisions on punishment of the party, position, rank, and the treatment of the matters; Party members subject to disciplinary action, not in accordance with the cadre management authority and organizational relationships of by dispose of Party members to carry out education and supervision of daily management. "What needs to be pointed out is," cliff "demoted with cars, housing, secretary problem, implementation is not a discipline and party posts and ranks treatment by the organization department is responsible for the implementation, with cars, housing by the logistics department is responsible for the implementation of, Ji Commission responsible oversight responsibilities. The six questions, about the acts violating the discipline of life "in violation of discipline of life behavior punishment", mainly to "four winds" problems and a serious violation of social morality, family virtue acts of misconduct made provisions on disciplinary, an increase of extravagant life, contrary to the social public order and good customs disciplinary terms. Worth mentioning is, > < Regulations in Article 150 60 about "adultery" "mistress (Cardiff) formulation in the new < rule > is removed, to expand the scope of Article 127 provisions" and others hair improper sexual relations, let face disciplinary action Wider more strict. Four, and earnestly do a good job in the < code > and < rule > implement system of life lies in execution. < code > and < Regulations > is 23 Party organizations at all levels of a strong constraint and all Party members follow. Learning and implementing the < code > and < rule > is party committees (party), commission for discipline, discipline inspection group), the majority of Party members and cadres of the common responsibility, must party caught together, the party one execution. () Party committees (party) and play and implement comprehensive strictly the main responsibility, pays special attention to the two party regulations learning cross penetration. One is to Adhere to the party constitution is fundamental to follow, and resolutely safeguard the authority of the Party Chapter. The second is to adhere to the problem oriented, to strictly political discipline and political rule moments in the first place. The third is to adhere to the discipline and rules quite in front must not allow the bottom line to break the discipline. The fourth is to seriously organize the study of propaganda and education, in the city party members to create a disciplined, about the rules of the strong atmosphere. (II) Commission for Discipline Inspection at all levels (Discipline Inspection Group) to an important basis for the revised two party regulations as, adhere to easily 61 blame, strengthen supervision and enforcement And early method in combining Ji, increase accountability efforts. One is to two regulations within the party important basis, adhere to the party constitution duties, with strict discipline to maintain the constitution authority. The second is to adhere to high standards and keep the bottom line, adhere to Ji Yan in law and discipline, the discipline and rules quite in front, grasping grasping small, easily blame, comprehensive use of supervision and discipline of "four kinds of form" in the discipline embodies the strict requirements and care for the discipline, tighten up, Yan. According to discipline in accordance with regulations to carry out disciplinary review. Increase the violations punishment, clues can initiate an investigation on the trial of cases According to the discipline on the provisions of the proportion of processing and control manager maintains discipline. To focus on investigating non convergence, don't accept hand serious disciplinary violations at the same time, pay more attention to the general review of discipline 24 behavior, and gradually increase the lighter punishment. Four is to illuminate two party regulations, combined with the local district of the Department of party conduct Lianzheng to relevant laws and regulations system clean, timely research proposes to establish, change, waste release opinion, avoid conflict, and the fasten system of cage, and gradually formed not rot, not rot, not want to rot system and working mechanism. (3) the leadership of the party members and cadres 62 should play an exemplary role. The rate of higher consciousness of the front of the Ordinance to lead practice self-discipline norms, leading to maintain discipline of seriousness and authority. One is the above rate, demonstration and guidance, take the lead in learning and mastering the < code > and < > the requirements and regulations, do the deep understanding, learning to use. The second is to play an exemplary role in abiding by discipline rate, take the lead in practicing self-discipline norms, firmly establish before the discipline are equal, the system has no privilege, discipline is no exception, and consciously do standards, require more strict measures more practical. Third is to consciously accept supervision, conscientiously participate in the democratic life and debriefing honesty responsibility, such as Real to the party organization to report personal matters, and to accept the supervision of the work and life of the normal, habits under the supervision of the exercise of power, to carry out the work. The fourth is to set an example for the strict enforcement of discipline. Leading cadres should take the lead in the maintenance of discipline of seriousness and authority, to dare to seriously, dare to struggle, dare to offend people, for misconduct not laissez faire, but do not indulge, not tolerate to ensure the party constitution of party compasses party put in place. (4) the majority of Party members and cadres to set high standards and hold the bottom line, consciously abide by the < code > and < rule >. One is to control the < standard > and < 25 cases >, tight Close connection 63 with their own thoughts, practical work and life, efforts to solve the problems, to enhance the study and implement of the effectiveness and pertinence. The second is to establish a high standard and hold the bottom line, consciously in the self-discipline pursuit of high standards, strictly in the party away from the red line discipline, discipline, about the rules and know fear, distrust, the formation of the honor system, comply with the system, safeguard system of good habits. Regulations and discipline regulations of < < New Revision of the Communist Party of China clean fingered self-discipline criterion > and < Chinese Communist Party Disciplinary Regulations > is the Party Central Committee in the new situation to promote the comprehensive strictly root of the lift, the regulations of the party construction of keeping pace with the times. We should study and implement the Standards > and < > as the primary political task, adhere to the party constitution duties, adhere to the discipline of, Ji Yan in law, the full implementation of supervision and discipline accountability responsibilities for coordination and promotion "four overall" strategic layout in XX District vivid practice to provide a strong guarantee. - Si Jian Wu, and effectively enhance the implementation of the implementation of the < code > < > The consciousness of General Secretary Xi pointed out that the party is in charge of the party, to manage the party; strictly, it can cure good party. Criterion > and < rule > keep pace 64 with the times is our party to form a new potential strictly rules, to deepen understanding of the ruling law, is a comprehensive strictly, and strengthen the supervision within the party important grasper. Criterion > closely linked to the theme of self-discipline, self-discipline intensity-modulated, focusing on morality, for the majority of Party members and cadres set to see, feel the high standard, show the Communists noble moral sentiment; District Ordinance < < rule > the constitution of discipline integration into a political discipline, organization and discipline, honesty and discipline, discipline of the masses, work discipline, discipline, emphasize discipline, focusing on established rules, to draw the party organizations and Party members do not touch the bottom line. Party committees (party) to effectively strengthen the study and publicize the implementation of the < code > and < rule > the organization and leadership of criterion > and < > a full range, multi angle, deep publicity, the formation of study and publicize and implement the boom, in order to consolidate the development of good political environment to create a positive environment and atmosphere. The majority of Party members and cadres to strict requirements, the < rule > and < Ordinance cases > as a guide to action and behavior criterion, adhere to the moral standards and discipline of the bottom line, to maintain the discipline of worship and awe, learning, compliance, and maintain party discipline and rules of the model. The discipline inspection and supervision organs and cadres to the < code > and < > as the deepening of 65 the "three", and strengthen supervision and discipline of accountability is important to follow correctly grasp the use of supervision and discipline of "four types", promote the comprehensive strictly in new roots. Strict discipline, adhere to the discipline and rules quite in front of the enterprise in the implementation of expensive to implement to execute. The discipline inspection and supervision organs to implement the < code > and < Efforts to investigate cases > as an opportunity, adhere to the party should manage the party strictly, serious performance of their duties to promote two regulations implementation. Change discipline concept. From the simple "investigation of illegal" to a comprehensive "stare at violate discipline"; from the business case to prosecute the big cases and timely solve the signs of tilt to. From the orientation to the normal supervision; from the tube "minority" to resist the "most". Guide Party members and cadres to seriously implement the < code > and < rule >, consciously abide by the political, organizational, honest people, work, life six discipline. Urge the leadership cadres sent to play an exemplary role, take the lead in strictly enforced. Relaxation and rest Strong wind is Su Ji, closely linked to the "four winds" prone to multiple, the masses reflect the strong important nodes and, glued to the four winds "new form, new trends, seriously investigate and deal with violations of the central eight provisions of the spirit, to increase the bulletin exposure intensity, the formation of Chajiu" four winds "loudly, continue to release and discipline 66 must be strict signal. At the same time, extended supervision tentacles, through the development of the rural and fishery party conduct Lianzheng construction inspection, issued in a timely manner, Chajiu occurred in grassroots side of corruption and unhealthy, and earnestly safeguard the interests of the masses and social stability. The creativity and discipline. Grasp and make good use of the supervision and discipline of" four types ", to ensure the Promoting clues to lots of discipline and the law of the vacuum tube, strict together. Not only to the "less" and "very few" thorough investigation severely punished, but also the "most" to maintain zero tolerance trend through layers of conductive pressure, let the discipline about the rules for each party members and cadres consciously follow. At present, it is necessary to implement the "list" management, strictly follow the clues to the disposal of five standards, make the classification of disposal, dynamic cleanup. Zadok Party committees at all levels to implement the main responsibility, comprehensive use of disciplinary action and tissue processing and other means to effectively curb the commonplace, used to see do not blame the "small problem", not because of "practice" and "exception". Prominent Discipline characteristics, the problems of violation of discipline and rules into the focus of supervision and discipline and disciplinary review. At the same time, increase case double check the intensity, the serious problems of discipline violations or "four winds" ban but not absolutely, not only to be 67 held directly responsible, but also held leadership responsibility; not only to pursue studies the main responsibility of the Party committee, and to pursue Commission for Discipline Inspection and supervision responsibilities and promote accountability to become the new norm. The implementation of supervisory responsibility. Maintain < code > and < rule > the seriousness and authority of the discipline and rules and truly become the party's ruler. Discipline as supervision within the party the specialized agency, we must strengthen the responsibility to act, adhere to the Impartial discipline accountability, earnestly will be strict discipline, discipline must be punished, and severely punish the acts in violation of rules and regulations. 68