Kannel W B
Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Massachusetts 02118.
J Cardiovasc Pharmacol. 1989;13 Suppl 1:S4-10. doi: 10.1097/00005344-198900131-00003.
Hypertension increases cardiovascular morbidity and mortality two- to fourfold. The chief hazards are now atherosclerosis and coronary disease. Risk is proportional to the degree of systolic or diastolic blood pressure elevation at any age, in either sex. More than the character of blood pressure elevation, commonly associated risk factors markedly influence the hazard. The risk of coronary heart disease is concentrated in hypertensive patients with a high total/high-density lipoprotein (HDL)-cholesterol ratio, impaired glucose tolerance, high fibrinogen, electrocardiographic (ECG) abnormalities, and who are cigarette smokers. Evidence of organ involvement such as left ventricular function are hallmarks of impending cardiovascular sequelae. Electrocardiogram-left ventricular hypertrophy (ECG-LVH) behaves like myocardial infarction in its clinical course, predisposing at the same rate to sudden death, infarction, cardiac failure, and stroke. Consideration of cardiovascular risk factors is required to evaluate properly the need for treatment, select the best treatment, set goals, and determine the efficacy of treatment. Awaiting evidence of organ involvement is dangerous since the first such evidence is often a sudden death, stroke, or myocardial infarction. Optimal treatment must improve the composite risk profile as well as lower the blood pressure.
高血压使心血管疾病的发病率和死亡率增加两到四倍。目前主要危害是动脉粥样硬化和冠心病。在任何年龄、任何性别中，风险与收缩压或舒张压升高的程度成正比。除了血压升高的特征外，常见的相关危险因素对风险有显著影响。冠心病风险集中在总胆固醇/高密度脂蛋白（HDL）胆固醇比值高、糖耐量受损、纤维蛋白原水平高、心电图（ECG）异常以及吸烟的高血压患者中。诸如左心室功能等器官受累的证据是即将发生心血管后遗症的标志。心电图左心室肥大（ECG-LVH）在临床过程中表现类似心肌梗死，以相同的速率易引发猝死、梗死、心力衰竭和中风。为了正确评估治疗需求、选择最佳治疗方法、设定目标并确定治疗效果，需要考虑心血管危险因素。等待器官受累的证据是危险的，因为首个此类证据往往是猝死、中风或心肌梗死。最佳治疗必须改善综合风险状况并降低血压。
