Sheps S G
Division of Hypertension, Mayo Clinic, Mayo Medical School and Foundation, Rochester, Minnesota 55905, USA.
Am J Hypertens. 1999 Aug;12(8 Pt 2):65S-72S. doi: 10.1016/s0895-7061(99)00111-9.
Treatment recommendations for hypertension as outlined in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) are constantly evolving and being refined as new information on the disease becomes evident. Uncontrolled hypertension is a major antecedent of stroke, heart failure, coronary heart disease, and end-stage renal disease. The increasing incidences of both cardiovascular and renal diseases fuel the need for improved control of hypertension. In fact, according to the National Health and Nutrition Examination Survey (NHANES), about 69% of Americans whose blood pressure is greater than 140/90 mm Hg are aware of it, about half are getting treatment for it, and only about one-quarter are adequately controlled. These observations fuel the need for improved patient management guidelines. JNC VI makes several changes from the previous JNC V to assist physicians in the diagnosis, treatment, and improved management of patients with hypertension. These changes include reporting adult blood pressure in two new ways, via staging and risk factor classification. A high-normal classification (systolic: 130 to 139 mm Hg, or diastolic: 85 to 89 mm Hg) is included in JNC VI because of the clinical importance of such blood pressure contributing to cardiovascular disease. Additionally, clinicians are advised to assign a patient to one of three risk categories that, in addition to hypertension stage, influence the decision to select antihypertensive drug therapy. Lifestyle modification is an important component at each stage. These and other changes and highlights of recent studies supporting the need for more intensive blood pressure control are discussed in this paper.
美国国家高血压预防、检测、评估与治疗联合委员会第六次报告（JNC VI）中概述的高血压治疗建议，随着有关该疾病的新信息日益明确，一直在不断演变和完善。未控制的高血压是中风、心力衰竭、冠心病和终末期肾病的主要先兆。心血管疾病和肾脏疾病发病率的不断上升，促使人们需要更好地控制高血压。事实上，根据美国国家健康与营养检查调查（NHANES），血压高于140/90 mmHg的美国人中，约69%知晓自己的血压情况，约一半人正在接受治疗，而只有约四分之一的人得到了充分控制。这些观察结果凸显了改进患者管理指南的必要性。JNC VI在先前的JNC V基础上做出了多项改变，以协助医生对高血压患者进行诊断、治疗和更好的管理。这些改变包括通过分期和危险因素分类这两种新方式报告成人血压。JNC VI纳入了高正常血压分类（收缩压：130至139 mmHg，或舒张压：85至89 mmHg），因为这种血压对心血管疾病的临床重要性。此外，建议临床医生将患者归入三个风险类别之一，除高血压分期外，这也会影响选择抗高血压药物治疗的决策。生活方式的改变在每个阶段都是重要组成部分。本文将讨论这些以及其他变化，以及支持更严格控制血压必要性的近期研究要点。
