Kannel W B
Drugs. 1986;31 Suppl 1:1-11. doi: 10.2165/00003495-198600311-00004.
Elevated blood pressure is a major contributor to cardiovascular disease in general and to coronary heart disease in particular, now its most common sequela. The risk is proportional to the degree of blood pressure elevation, at all ages and in either sex, whether the increased pressure is labile or fixed, diastolic or systolic in character. The effect of blood pressure on cardiovascular disease incidence is independent of the influence of other predisposing co-factors, but the hazard is greatly influenced by them. Elevated pressures are often accompanied by hyperlipidaemia, hyperuricaemia, overweight, hyperglycaemia, elevated fibrinogen values and ECG abnormalities. The risk associated with any degree of elevation of pressure varies greatly, depending on the number and level of these often associated risk factors, and on whether or not there is the indication of target organ involvement. The excess cardiovascular risk in hypertensive persons tends to be concentrated in those with an increased LDL/HDL cholesterol ratio, impaired glucose tolerance, cigarette smokers and those with accompanying ECG abnormalities. Hypertension is best conceptualised as a component of a multivariate cardiovascular risk profile which provides a sound basis for determining urgency for drug treatment. Optimal preventive management of hypertension requires multifactorial correction of all disordered components of the cardiovascular risk profile before occurrence of target organ involvement.
一般而言，血压升高是心血管疾病的主要促成因素，尤其是冠心病的主要促成因素，而冠心病是目前最常见的后遗症。无论年龄大小、性别如何，无论血压升高是不稳定的还是固定的，是舒张期的还是收缩期的，风险都与血压升高的程度成正比。血压对心血管疾病发病率的影响独立于其他诱发共同因素的影响，但危害会受到这些因素的极大影响。血压升高常伴有高脂血症、高尿酸血症、超重、高血糖、纤维蛋白原值升高和心电图异常。与任何程度的血压升高相关的风险差异很大，这取决于这些常伴有的风险因素的数量和水平，以及是否有靶器官受累的迹象。高血压患者中额外的心血管风险往往集中在低密度脂蛋白/高密度脂蛋白胆固醇比值升高、糖耐量受损、吸烟者以及伴有心电图异常的人群中。最好将高血压理解为多变量心血管风险概况的一个组成部分，这为确定药物治疗的紧迫性提供了坚实的基础。高血压的最佳预防性管理需要在靶器官受累之前对心血管风险概况的所有紊乱成分进行多因素纠正。
