Yannoutsos A, Mourad J-J, Blacher Jacques, Safar M
Unité Hypertension Artérielle, Prévention et Thérapeutique Cardiovasc., Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, Université Paris.
Praxis (Bern 1994). 2010 Nov 3;99(22):1335-41. doi: 10.1024/1661-8157/a000305.
The optimization of the pharmacologic treatment in hypertensive patients is encouraged by four reports: the high prevalence of hypertension and more particularly in the elderly, the lack of blood pressure control in more than half of patients, the frequency of the association to other cardiovascular risk factors and the existence of a residual risk under treatment. All these factors are combined to raise the cardiovascular risk in hypertensive patients. Several interventional studies highlighted a reduction of the cardiovascular risk proportional to the reduction of blood pressure under treatment. Thus arose the question of the optimal blood pressure: the guidelines propose values lower than 140/90 mmHg for the non-complicated essential hypertension and lower than 130/80 mmHg in secondary prevention, for the patients with diabetes or renal impairment. However, this strict blood pressure goal for the high cardiovascular risk patients is not confirmed by clinical trials, strict blood pressure goal being potentially deleterious. The concept of «the lower the better» tends to be abandoned. Since more than three decades, the assumption of a paradoxical increase of the cardiovascular morbidity and mortality associated with a high reduction of blood pressure (the «J-Curve» concept) remains the subject of many studies and controversies.
高血压的高患病率，尤其是在老年人中的患病率；超过一半的患者血压未得到控制；与其他心血管危险因素并存的频率；以及治疗后仍存在残余风险。所有这些因素共同作用，增加了高血压患者的心血管风险。多项干预性研究强调，心血管风险的降低与治疗中血压的降低成比例。因此出现了最佳血压的问题：指南建议，对于非复杂性原发性高血压，血压值应低于140/90 mmHg；对于二级预防中的糖尿病或肾功能损害患者，血压值应低于130/80 mmHg。然而，临床试验并未证实针对高心血管风险患者设定的这一严格血压目标，严格的血压目标可能有害。“越低越好”的概念逐渐被摒弃。三十多年来，与血压大幅降低相关的心血管发病率和死亡率反常增加的假设（“J曲线”概念）仍是许多研究和争议的主题。
