Viera Anthony J
Department of Community and Family Medicine Duke University School of Medicine, Box 2914 DUMC, Durham, NC 27710.
FP Essent. 2018 Jun;469:11-15.
Hypertension affects at least 1 in 3 American adults and is a major contributor to premature mortality. Current guidelines recommend screening all adults for hypertension. Ambulatory blood pressure (BP) monitoring should be used to confirm the diagnosis of hypertension for most adults before starting antihypertensive drugs. Ambulatory BP monitoring is the preferred method but home BP monitoring is an acceptable alternative. Management of hypertension substantially reduces the risk of heart failure, stroke, and myocardial infarction. Recommended lifestyle modifications include weight loss for overweight or obese patients, regular exercise, the Dietary Approaches to Stop Hypertension (DASH) diet, reduced dietary sodium intake, and reduced alcohol intake. Most hypertensive patients will need at least two drugs to control BP. Although not endorsed by the American Academy of Family Physicians, recent guidelines from the American College of Cardiology and American Heart Association state that a BP level goal of less than 130/80 mm Hg for adults with confirmed hypertension and without additional markers of increased atherosclerotic cardiovascular disease (ASCVD) risk may be reasonable. Decisions regarding when to start antihypertensive drugs are based in part on cardiovascular risk.
高血压影响着至少三分之一的美国成年人，是过早死亡的主要原因。现行指南建议对所有成年人进行高血压筛查。对于大多数成年人，在开始使用降压药物之前，应采用动态血压监测来确诊高血压。动态血压监测是首选方法，但家庭血压监测也是一种可接受的替代方法。高血压的管理可大幅降低心力衰竭、中风和心肌梗死的风险。推荐的生活方式改变包括超重或肥胖患者减重、定期锻炼、采用终止高血压膳食疗法（DASH）饮食、减少饮食中的钠摄入量以及减少酒精摄入量。大多数高血压患者至少需要两种药物来控制血压。虽然未得到美国家庭医师学会的认可，但美国心脏病学会和美国心脏协会最近的指南指出，对于确诊高血压且无动脉粥样硬化性心血管疾病（ASCVD）风险增加的其他标志物的成年人，血压目标值低于130/80 mmHg可能是合理的。关于何时开始使用降压药物的决策部分基于心血管风险。
