Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
Departments of Epidemiology and Medicine, Tulane University, New Orleans, Louisiana, USA.
Curr Opin Cardiol. 2021 Jul 1;36(4):429-435. doi: 10.1097/HCO.0000000000000864.
Hypertension is the foremost risk factor for cardiovascular disease (CVD) and death. This review highlights recent findings that apply to the prevention, detection, and management of high blood pressure (BP), in the context of the 2017 American College of Cardiology/American Heart Association BP guideline.
Several new findings on the association of BP measurement with CVD outcomes are now available. (1) Beginning with a systolic BP (SBP) as low as 90 mm Hg, coronary artery calcium deposition and the risk of incident atherosclerotic CVD (ASCVD) increased in stepwise fashion with increasing SBP levels within the normal range in adults at low risk for ASCVD. (2) Isolated diastolic hypertension was not associated with ASCVD, heart failure, or chronic kidney disease. (3) Nocturnal BP appeared to be better associated with CVD outcomes than office or daytime BP. (4) In a head-to-head comparison, home BP monitoring had higher reliability and predictive value than office or ambulatory BP to detect left ventricular hypertrophy, an intermediate form of hypertension-related target organ damage. In addition, new information indicates that autonomous aldosterone production is present in a substantially larger percentage of adults with hypertension than previously recognized. Finally, intensive BP lowering is associated with a significant reduction in the incidence of mild cognitive impairment, a precursor of dementia.
Ongoing research has made significant progress in the prevention, detection, and management of high BP, clarifying, amplifying, and/or supporting the 2017 ACC/AHA BP guideline recommendations.
高血压是心血管疾病（CVD）和死亡的首要危险因素。本综述重点介绍了 2017 年美国心脏病学会/美国心脏协会血压指南背景下，适用于高血压预防、检测和管理的最新研究发现。
目前有一些关于血压测量与 CVD 结局之间关系的新发现。（1）在低危 ASCVD 成人中，正常范围内的 SBP 水平逐渐升高，即使 SBP 低至 90mmHg，冠状动脉钙沉积和 ASCVD 事件风险也呈阶梯式增加。（2）单纯舒张期高血压与 ASCVD、心力衰竭或慢性肾脏病无关。（3）夜间血压似乎比诊室或日间血压更好地与 CVD 结局相关。（4）在头对头比较中，家庭血压监测比诊室或动态血压监测具有更高的可靠性和预测价值，可检测到左心室肥厚，这是高血压相关靶器官损害的一种中间形式。此外，新信息表明，自主醛固酮生成在高血压患者中的比例比以前认为的要高得多。最后，强化降压与轻度认知障碍（痴呆的前兆）发生率的显著降低相关。
总之，正在进行的研究在高血压的预防、检测和管理方面取得了重大进展，阐明、放大和/或支持了 2017 年 ACC/AHA 血压指南建议。
