Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.
Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
J Clin Hypertens (Greenwich). 2020 Mar;22(3):344-350. doi: 10.1111/jch.13714. Epub 2019 Nov 19.
It is widely accepted that hypertension constitutes a significant cardiovascular risk factor and that treating high blood pressure (BP) effectively reduces cardiovascular risk. An important issue in Asia is not just the high prevalence of hypertension, particularly in some countries, but also the low level of awareness and treatment rates in many regions. The 2017 update of the American College of Cardiology/American Heart Association hypertension guidelines raised the question about which BP threshold should be used to diagnose and treat hypertension. Although there is a theoretical rationale for a stricter BP criterion in Asia given the ethnic-specific features of hypertension in the region, the majority of countries in Asia have retained a diagnostic BP threshold of ≥140/90 mm Hg. Although lowering thresholds might make theoretical sense, this would increase the prevalence of hypertension and also markedly reduce BP control rates. In addition, there are currently no data from robust randomized clinical trials of the benefits of the lower targets in preventing cardiovascular disease and reducing cardiovascular risk, particularly in high-risk patients and especially for Asian populations. There is also no defined home BP treatment target level for an office BP treatment target of 130/80 mm Hg. However, in this regard, in the interim, lifestyle modifications, including reducing body weight and salt intake, should form an important part of hypertension management strategies in Asia, while studies on treating at lower BP threshold level in Asians and getting to lower BP targets will be helpful to inform and optimize the management of hypertension in the region.
人们普遍认为，高血压是一个重要的心血管危险因素，有效治疗高血压（BP）可以降低心血管风险。亚洲的一个重要问题不仅是高血压的高患病率，特别是在一些国家，而且在许多地区的知晓率和治疗率都很低。2017 年美国心脏病学会/美国心脏协会高血压指南的更新提出了一个问题，即应该使用哪个 BP 阈值来诊断和治疗高血压。尽管鉴于该地区高血压的种族特异性特征，亚洲有一个更严格的 BP 标准的理论依据，但亚洲的大多数国家仍保留了≥140/90mmHg 的诊断 BP 阈值。虽然降低阈值在理论上可能有意义，但这将增加高血压的患病率，并显著降低 BP 控制率。此外，目前还没有关于较低目标在预防心血管疾病和降低心血管风险方面的益处的来自强有力的随机临床试验的数据，特别是在高危患者中，尤其是在亚洲人群中。对于 130/80mmHg 的诊室 BP 治疗目标，也没有明确的家庭 BP 治疗目标水平。然而，在这方面，在临时阶段，生活方式的改变，包括减轻体重和减少盐的摄入，应该成为亚洲高血压管理策略的重要组成部分，而在亚洲人群中以较低的 BP 阈值进行治疗并达到较低的 BP 目标的研究将有助于为该地区的高血压管理提供信息和优化。
