Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524C, Baltimore, MD, 21287, USA.
Ciccarone Center for the Prevention of Heart Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Curr Cardiol Rep. 2018 Sep 26;20(11):108. doi: 10.1007/s11886-018-1063-y.
Recent US guidelines have changed the definition of hypertension to ≥ 130/80 mmHg and recommended more intense blood pressure (BP) targets. We summarize the evidence for intense BP treatment and discuss risks that must be considered when choosing treatment goals for individual patients.
The SPRINT study reported that treating to a systolic BP target of 120 mmHg reduces cardiovascular outcomes in high-risk individuals, supporting more intensive BP reduction than previously recommended. However, recent observational studies have placed emphasis on the BP J-curve phenomenon, where low BPs are associated with adverse cardiovascular outcomes, suggesting that overly aggressive BP targets may sometimes be harmful. We attempt to reconcile these apparent contradictions for the clinician. We also review other potential dangers of aggressive BP targets, including syncope, renal impairment, polypharmacy, drug interactions, subjective drug side-effects, and non-adherence. We suggest a personalized approach to BP drug management considering individual risks, benefits, and preferences when choosing therapeutic targets, recognizing that a goal of 130/80 mmHg should always be considered. Additionally, we recommend an intense focus on lifestyle changes and medication adherence.
最近的美国指南将高血压定义更改为≥130/80mmHg，并建议将血压目标值设定得更低。我们总结了强化降压治疗的证据，并讨论了当为个体患者选择治疗目标时必须考虑的风险。
SPRINT 研究报告称，将收缩压目标值降至 120mmHg 可降低高危人群的心血管结局，支持比之前建议的更积极的降压治疗。然而，最近的观察性研究强调了血压 J 型曲线现象，即较低的血压与心血管不良结局相关，这表明过于激进的降压目标有时可能有害。我们试图为临床医生协调这些明显的矛盾。我们还回顾了强化降压目标的其他潜在危害，包括晕厥、肾功能损害、多种药物治疗、药物相互作用、药物不良反应、以及不遵医嘱。我们建议在选择治疗目标时，根据个体风险、获益和偏好，采取个体化的降压药物管理方法，同时始终考虑 130/80mmHg 的目标值。此外，我们建议高度关注生活方式改变和药物依从性。
