Kawachi I, Wilson N
Department of Community Health, Wellington School of Medicine, New Zealand.
Soc Sci Med. 1990;31(11):1239-43. doi: 10.1016/0277-9536(90)90130-k.
The goal of antihypertensive therapy has changed dramatically over the past 40 years. What was once a treatment for a life-threatening disease has gradually evolved to become just one of the many ways of modifying a symptomless risk factor. The development of safer drugs throughout the 1970s resulted in treatment being offered at successively lower levels of blood pressure elevation, and consequently to an ever increasing proportion of the population. Based on new evidence from clinical trials, however, recent policy guidelines for the treatment of hypertension--especially mild hypertension--have become more conservative. Yet, there are a number of reasons for doubting that this policy reversal will be transmitted into actual clinical practice, unless major changes are made to the arrangement of structural interests--professional, industrial and third-party funders--which currently support and maintain antihypertensive therapy on a mass scale. Meanwhile, 'control' of blood pressure, 'quality of life', and 'compliance' with therapy have become ends in themselves, often to the exclusion of much-needed discussion on the real therapeutic goal of antihypertensive medication, i.e., the prevention of cardiovascular and cerebrovascular morbidity and mortality and the question of whether drugs are always the best way to achieve this.
在过去40年里，抗高血压治疗的目标发生了巨大变化。曾经作为一种治疗危及生命疾病的方法，已逐渐演变成只是改变无症状风险因素的众多方式之一。整个20世纪70年代更安全药物的研发，使得治疗开始针对血压升高程度越来越低的情况，从而治疗人群比例不断增加。然而，基于临床试验的新证据，近期高血压治疗——尤其是轻度高血压——的政策指南变得更加保守。然而，有诸多理由怀疑，除非对目前大规模支持和维持抗高血压治疗的结构利益相关方——专业人士、产业界和第三方资助者——的安排做出重大改变，否则这种政策逆转不会转化为实际临床实践。与此同时，血压“控制”、“生活质量”以及对治疗的“依从性”本身已成为目标，常常排除了对抗高血压药物真正治疗目标（即预防心脑血管发病和死亡以及药物是否始终是实现这一目标的最佳方式）进行急需讨论的可能性。
