Division of Cardiology and Cardiovascular Pathophysiology, Hospital S. Maria della Misericordia, Perugia, Italy.
Department of Medicine, University of Perugia, Perugia, Italy.
Eur J Intern Med. 2019 May;63:3-8. doi: 10.1016/j.ejim.2019.01.016. Epub 2019 Feb 4.
Hypertension is one of the most common chronic diseases in adults and a leading cause of disability and mortality worldwide. Recently, new Guidelines for the diagnosis and management of hypertension have been released in Europe and in the United States, with changes regarding how to diagnose and treat the condition, and the extent to which intensive blood pressure control should be pursued. Important differences between the Guidelines exist in the classification of blood pressure levels and definition of treatment goals. Diagnosis of hypertension starts at 140/90 mmHg for the European Guidelines, and 130/80 mmHg for the US Guidelines. Besides, the European guidelines introduced the concept of "safety boundaries", consisting of BP thresholds not to be exceeded towards lower levels (120 mmHg for age < 65 years, 130 mmHg for older people) because of the fear of important adverse events associated with overtreatment. Such discrepancies can indeed have an impact on treatment attitudes and outcome incidence. Hence, we appraised facts in favor and against each of these controversial issues. In conclusion we believe that, instead of fixing rigid BP targets and boundaries, modern hypertension management should be aimed to achieve in each patient an optimal balance between intensive BP reduction and treatment safety.
高血压是成年人中最常见的慢性病之一，也是全球残疾和死亡的主要原因。最近，欧洲和美国发布了新的高血压诊断和管理指南，对如何诊断和治疗该疾病以及应在多大程度上追求强化血压控制进行了修改。指南之间存在重要差异，体现在血压水平的分类和治疗目标的定义上。欧洲指南将高血压的诊断标准定为 140/90mmHg，而美国指南则定为 130/80mmHg。此外，欧洲指南引入了“安全界限”的概念，包括不应超过的较低血压阈值（<65 岁者为 120mmHg，老年人为 130mmHg），因为担心与过度治疗相关的重要不良事件。这些差异确实会对治疗态度和结果发生率产生影响。因此，我们评估了支持和反对这些有争议问题的事实。总之，我们认为，现代高血压管理的目标不应该是固定的血压目标和界限，而应该是在每个患者中实现强化降压和治疗安全性之间的最佳平衡。
