Germino F Wilford
Department of Internal Medicine, Orland Primary Care Specialists, Orland Park, Illinois 60467, USA.
Clin Cornerstone. 2009;9 Suppl 3:S27-33. doi: 10.1016/s1098-3597(09)60016-8.
High blood pressure (HBP) is one of the most prevalent conditions seen today by clinicians, affecting an estimated 73 million--or 1 in 3--adult Americans, only one third of whom have achieved control of their hypertension (HBP). Central to the management of this pervasive medical condition are the issues of accurate diagnosis and maintaining control through appropriate treatment. Accurate diagnosis depends primarily on reliable measurement. Over the years, it has become increasingly recognized that blood pressure (BP) measurement occurring in clinical settings produces far less accurate and reliable readings than do other methods, notably 24-hour ambulatory BP monitoring and home BP measurement. Beyond technique, there are additional challenges to obtaining accurate readings, including emotional factors that produce either falsely elevated or lowered results, having the potential to mislead the clinician. The need to overcome obstacles to proper diagnosis and determine effective treatments has reached heightened urgency, especially for patients with compelling comorbidities such as diabetes, renal disease, congestive heart failure, and other cardiovascular diseases. The continuing evolution of the management of HBP is reflected in updated guidelines from the American Heart Association and evidence-based information stemming from recent studies and randomized clinical trials. The appropriate selection of antihypertensive agents, at the proper doses, is a complex issue requiring greater understanding of our pharmacologic options. The contributions of some of the more recent and salient studies and trials are mentioned here, although there is no attempt in this brief review to match drug classes with compelling indications. The trials discussed involve such pharmacologic treatments as diuretic therapy, alpha-blockers, conventional beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers. Trial outcomes shed light on the relative benefits and drawbacks of these agents, often within the context of various patient characteristics such as age, comorbidities, and risk status. Successful management of HBP is a multi-faceted and ongoing endeavor, in which developing knowledge constantly tempered by new questions moves us toward the goal of improving the lives of our patients.
高血压（HBP）是当今临床医生所见的最常见病症之一，估计影响7300万成年美国人——即三分之一的美国成年人，其中只有三分之一的人高血压得到了控制。对于这种普遍存在的病症的管理，关键在于准确诊断以及通过适当治疗维持血压控制。准确诊断主要依赖于可靠的测量。多年来，人们越来越认识到，在临床环境中进行的血压（BP）测量所产生的读数远不如其他方法准确和可靠，特别是24小时动态血压监测和家庭血压测量。除了技术问题外，获取准确读数还存在其他挑战，包括导致结果错误升高或降低的情绪因素，这有可能误导临床医生。克服正确诊断的障碍并确定有效治疗方法的需求变得更加紧迫，特别是对于患有糖尿病、肾病、充血性心力衰竭和其他心血管疾病等严重合并症的患者。高血压管理的持续演变反映在美国心脏协会的最新指南以及近期研究和随机临床试验得出的循证信息中。以适当剂量合理选择抗高血压药物是一个复杂的问题，需要对我们的药物选择有更深入的了解。这里提到了一些最新和突出的研究及试验的贡献，尽管在这篇简短的综述中没有尝试将药物类别与明确的适应症相匹配。所讨论的试验涉及利尿剂治疗、α受体阻滞剂、传统β受体阻滞剂、钙通道阻滞剂、血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂等药物治疗。试验结果揭示了这些药物的相对益处和缺点，通常是在年龄、合并症和风险状况等各种患者特征的背景下。高血压的成功管理是一项多方面的持续努力，在这个过程中，不断发展的知识不断受到新问题的检验，推动我们朝着改善患者生活的目标前进。
