Aronow Wilbert S
Cardiology Division, Department of Medicine, New York Medical College Valhalla, New York, USA.
Am J Cardiovasc Dis. 2012;2(3):160-70. Epub 2012 Jul 25.
Systemic hypertension is a major risk factor for cardiovascular disease and is present in 69% of patients with a first myocardial infarction, in 77% of patients with a first stroke, in 74% of patients with chronic heart failure, and in 60% of patients with peripheral arterial disease. Double-blind, randomized, placebo-controlled trials have found that antihypertensive drug therapy reduces cardiovascular events in patients aged younger than 80 years and in patients aged 80 years and older in the Hypertension in the Very Elderly Trial. Although the optimal blood pressure treatment goal has not been determined, existing epidemiologic and clinical trial data suggest that a reasonable therapeutic blood pressure goal should be <140/90 mm Hg in patients younger than 80 years and a systolic blood pressure of 140-145 mm Hg if tolerated in patients aged 80 years and older. Non-pharmacologic lifestyle measures should be encouraged both to prevent development of hypertension and as adjunctive therapy in patients with hypertension. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, and diuretics have all reduced cardiovascular events in randomized trials. The choice of specific drugs depends on efficacy, tolerability, presence of specific comorbidities, and cost.
系统性高血压是心血管疾病的主要危险因素，在首次发生心肌梗死的患者中占69%，在首次发生中风的患者中占77%，在慢性心力衰竭患者中占74%，在外周动脉疾病患者中占60%。双盲、随机、安慰剂对照试验发现，在高龄老人高血压试验中，抗高血压药物治疗可降低80岁及以下患者和80岁及以上患者的心血管事件。虽然尚未确定最佳血压治疗目标，但现有的流行病学和临床试验数据表明，80岁以下患者合理的治疗血压目标应为<140/90 mmHg，80岁及以上患者如果能够耐受，收缩压目标应为140 - 145 mmHg。应鼓励采取非药物生活方式措施来预防高血压的发生，并作为高血压患者的辅助治疗。在随机试验中，血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂、钙通道阻滞剂和利尿剂均能降低心血管事件。具体药物的选择取决于疗效、耐受性、特定合并症的存在情况以及成本。
