Shrout Tara, Rudy David W, Piascik Michael T
The University of Kentucky College of Medicine, Class of 2018, NIH TL1 Training Program 2016-2017, USA.
Department of Internal Medicine, Division of General Internal Medicine and the Department of Pharmacology and Nutritional Sciences, The University of Kentucky College of Medicine, USA.
Curr Opin Pharmacol. 2017 Apr;33:41-46. doi: 10.1016/j.coph.2017.03.004. Epub 2017 May 16.
Hypertension is the most preventable major risk factor for cardiovascular morbidity and mortality. The etiology of elevated blood pressure is a complex process involving the interaction of genetics, demographics, comorbid disorders, and environmental influences. Effective hypertensive therapy has been shown to reduce cardiovascular morbidity and mortality. JNC reports have served as a valuable source of guidelines, and JNC 8 is the most recently updated guideline for the prevention, diagnosis, and treatment of hypertension. It includes modification of JNC 7 regarding the threshold for therapy, therapeutic goals, and medications or combinations of medications that differ in benefits for certain patient populations. However, JNC 8 generated a significant degree of controversy. This review will evaluate JNC 7 versus JNC 8 guidelines and discuss the most controversial aspects of JNC 8 through a therapeutic perspective. This review will also discuss the most recently available evidence that has an impact on the JNC 8 recommendations. Despite the nuance of clinical guidelines, blood pressure control rates remains suboptimal. We will explore potential reasons and solutions for this dilemma including pharmacogenomics, novel risk-stratification strategies, lifestyle interventions, and integrative care.
高血压是心血管疾病发病和死亡最可预防的主要危险因素。血压升高的病因是一个复杂的过程,涉及遗传、人口统计学、合并症以及环境因素的相互作用。有效的高血压治疗已被证明可降低心血管疾病的发病率和死亡率。美国国立综合癌症网络(JNC)报告一直是指南的重要来源,而JNC 8是最新更新的高血压预防、诊断和治疗指南。它包括对JNC 7在治疗阈值、治疗目标以及对某些患者群体益处不同的药物或药物组合方面的修订。然而,JNC 8引发了很大程度的争议。本综述将评估JNC 7与JNC 8指南,并从治疗角度讨论JNC 8最具争议的方面。本综述还将讨论对JNC 8建议有影响的最新可用证据。尽管临床指南存在细微差别,但血压控制率仍不理想。我们将探讨这一困境的潜在原因和解决方案,包括药物基因组学、新的风险分层策略、生活方式干预和综合护理。