Mancia Giuseppe
Department of Medicine, University of Milano-Bicocca Ospedale San Gerardodi Monza, Italy.
J Hypertens Suppl. 2006 Apr;24(2):S17-24. doi: 10.1097/01.hjh.0000220099.12154.c1.
Recognition that cardiovascular risk factors, such as hypertension, dyslipidaemia and diabetes mellitus, often cluster together has focused attention on the concept of total cardiovascular risk. Most current hypertension management guidelines emphasize the importance of assessing and managing the total risk in an individual patient. Due to the presence of additional risk factors, target-organ damage and associated clinical conditions, patients may be at high risk of cardiovascular events even when their blood pressure is normal or high-normal (systolic blood pressure 130-139 mmHg, diastolic blood pressure 80-89 mmHg). Such high-risk patients, although common in clinical practice, are often under-diagnosed. Intensive hypertensive therapy is recommended for high-risk patients. In most cases, this will necessitate combination therapy with two or more drugs. Moreover, antihypertensive therapy should form one component of a multifactorial approach aimed at treating all reversible risk factors. In the future, research should be aimed at controlling or reversing subclinical target-organ damage, the ultimate aim being to prevent the progression of cardiovascular risk in individuals at low or medium risk.
认识到心血管危险因素，如高血压、血脂异常和糖尿病，常常聚集在一起，这使得人们将注意力集中在总体心血管风险的概念上。目前大多数高血压管理指南都强调评估和管理个体患者总体风险的重要性。由于存在其他危险因素、靶器官损害和相关临床情况，即使患者血压正常或处于高正常范围（收缩压130 - 139 mmHg，舒张压80 - 89 mmHg），他们也可能处于心血管事件的高风险中。这类高风险患者在临床实践中很常见，但往往诊断不足。建议对高风险患者进行强化高血压治疗。在大多数情况下，这将需要两种或更多药物的联合治疗。此外，降压治疗应成为旨在治疗所有可逆危险因素的多因素方法的一个组成部分。未来，研究应致力于控制或逆转亚临床靶器官损害，最终目标是预防低风险或中等风险个体的心血管风险进展。
