Spiering Wilko, Grobbee Diederick E
Universitair Medisch Centrum Utrecht, Utrecht.
Ned Tijdschr Geneeskd. 2013;157(47):A5638.
A relationship between blood pressure level and cardiovascular morbidity and mortality can be demonstrated by way of a J-curve. The curve's lowest point, the optimal blood pressure, does not appear to be the same for all patients. The target blood pressure values found in guidelines are partly based on randomised interventional studies in which different target values have been compared. The general advised target blood pressure is < 140/90 mmHg for patients with cardiovascular disease or chronic kidney disease. For patients with diabetes mellitus the target blood pressure is < 140/85 mmHg. It has been proven that blood pressure-lowering agents are effective for patients above 80 years who are hypertensive; the target values in these patients are SBP: 140-150 mmHg and DBP: 70-80 mmHg.Lowering the blood pressure in the fragile elderly should be carried out with caution. In patients with coronary heart disease or diabetes mellitus, the optimal blood pressure for preventing a stroke could be lower than for preventing a myocardial infarction.
血压水平与心血管疾病的发病率和死亡率之间的关系可以通过J曲线来证明。曲线的最低点即最佳血压,似乎并非对所有患者都相同。指南中所发现的目标血压值部分基于随机干预研究,在这些研究中对不同的目标值进行了比较。对于患有心血管疾病或慢性肾病的患者,一般建议的目标血压为<140/90 mmHg。对于糖尿病患者,目标血压为<140/85 mmHg。已证实降压药物对80岁以上的高血压患者有效;这些患者的目标值为收缩压:140 - 150 mmHg,舒张压:70 - 80 mmHg。在身体虚弱的老年人中降低血压应谨慎进行。对于冠心病或糖尿病患者,预防中风的最佳血压可能低于预防心肌梗死的最佳血压。