Izzo Joseph L
Department of Medicine, State University of New York at Buffalo, Buffalo, New York, USA.
Pol Arch Med Wewn. 2011 Sep;121(9):303-9.
Antihypertensive medications are used to lower blood pressure (BP) but, ultimately, their true value lies in reductions in morbidity and mortality (cardiovascular, cerebrovascular, and renal diseases). Hypertension is defined discreetly (generally 140/90 mmHg) but the actual relationship between BP and adverse cardiac and cerebrovascular outcomes is continuous. Observational studies have demonstrated a powerful log-linear relationship between BP and mortality due to ischemic heart disease (IHD) or stroke over the range of 115/75 to 185/115 mmHg. Clinical trials and meta-analyses have clearly demonstrated benefits of antihypertensive drugs in nonhypertensive individuals: delay or prevention of the onset of hypertension and microalbuminuria and reduced morbidity and mortality from IHD, stroke, and chronic kidney disease. This is not surprising given that various antihypertensive drug classes have multiple potential beneficial effects. A persistent concern is that overtreatment of hypertension may increase risk in individuals with coronary artery disease, but a "J-curve" effect is not consistently found in clinical studies. The use of antihypertensive drugs in at-risk individuals who are below the traditional threshold (140/90 mmHg) is fully justifiable, but the decision requires adequate clinical experience and judgment and a full assessment of risks and benefits.
抗高血压药物用于降低血压（BP），但其真正价值最终在于降低发病率和死亡率（心血管、脑血管和肾脏疾病）。高血压有明确的定义（一般为140/90 mmHg），但血压与不良心脏和脑血管结局之间的实际关系是连续的。观察性研究表明，在115/75至185/115 mmHg范围内，血压与缺血性心脏病（IHD）或中风导致的死亡率之间存在强大的对数线性关系。临床试验和荟萃分析清楚地证明了抗高血压药物对非高血压个体的益处：延迟或预防高血压和微量白蛋白尿的发生，以及降低IHD、中风和慢性肾病的发病率和死亡率。鉴于各种抗高血压药物类别具有多种潜在有益作用，这并不奇怪。一个持续存在的担忧是，高血压的过度治疗可能会增加冠心病患者的风险，但在临床研究中并未始终发现“J曲线”效应。在低于传统阈值（140/90 mmHg）的高危个体中使用抗高血压药物是完全合理的，但这一决定需要足够的临床经验和判断力以及对风险和益处的全面评估。
