Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
Departments of Epidemiology and Medicine, Tulane University, New Orleans, Louisiana, USA.
Curr Opin Cardiol. 2022 Jul 1;37(4):317-325. doi: 10.1097/HCO.0000000000000980.
High blood pressure (BP) is the world's leading risk factor for cardiovascular disease (CVD) and death. This review highlights findings during the past 18 months that apply to the management of high BP in adults in the context of the 2017 American College of Cardiology/American Heart Association (AHA) BP guideline.
A comprehensive meta-analysis of clinical trials that employed a novel statistical method identified a substantially linear relationship between dietary sodium intake and BP, strongly supporting the AHA daily dietary sodium intake recommendation of less than 1500 mg/day but suggesting that any reduction in sodium intake is likely to be beneficial. Among adults with hypertension, use of a salt substitute (containing reduced sodium and enhanced potassium) led to striking reductions in CVD outcomes. Young adults with stage 1 hypertension and a low 10-year atherosclerotic CVD risk score should be started on a 6-month course of vigorous lifestyle modification; if their BP treatment goal is not achieved, a first-line antihypertensive agent should be added to the lifestyle modification intervention. In patients with stage 4 renal disease, the thiazide-like diuretic chlorthalidone (as add-on therapy) lowered BP markedly compared with placebo. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) represent a new class of MRA that has been shown to lower BP and provide significant CVD protection. In Chinese adults aged 60-80 years at baseline, intensive BP control with a SBP target of 110-129 compared with 130-149 mmHg reduced CVD events with minimal side effects.
Recent findings have advanced our knowledge of hypertension management, clarifying, amplifying and supporting the 2017 ACC/AHA BP guideline recommendations.
高血压（BP）是全球导致心血管疾病（CVD）和死亡的首要危险因素。本综述重点介绍了过去 18 个月内的研究结果，这些结果在 2017 年美国心脏病学会/美国心脏协会（AHA）BP 指南的背景下，适用于成年人高血压的管理。
一项采用新的统计方法的临床试验综合分析确定了膳食钠摄入量与 BP 之间存在实质性线性关系，这有力地支持了 AHA 每日摄入少于 1500mg 的钠的建议，但表明减少钠的摄入量可能是有益的。在高血压成年人中，使用盐替代品（含减少的钠和增强的钾）可显著降低 CVD 结局。10 年动脉粥样硬化性 CVD 风险评分低的 1 期高血压的年轻成年人应开始进行为期 6 个月的强化生活方式改变；如果他们的 BP 治疗目标未达到，则应在生活方式改变干预中添加一线抗高血压药物。在 4 期肾病患者中，噻嗪类利尿剂氯噻酮（作为附加疗法）与安慰剂相比显著降低 BP。非甾体类盐皮质激素受体拮抗剂（MRAs）是一种新的 MRA 类别，已被证明可降低 BP 并提供显著的 CVD 保护。在中国，基线年龄为 60-80 岁的成年人中，与收缩压目标为 130-149mmHg 相比，收缩压目标为 110-129mmHg 的强化 BP 控制可降低 CVD 事件发生率，且副作用最小。
最近的发现提高了我们对高血压管理的认识，阐明、放大和支持了 2017 年 ACC/AHA BP 指南建议。
