Townsend Raymond R
University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
Hypertension. 2025 Oct;82(10):1559-1568. doi: 10.1161/HYPERTENSIONAHA.125.25468. Epub 2025 Aug 28.
Elevated blood pressure (BP) is the most important noncommunicable disorder worldwide. Finding and effectively managing elevated BP is the single greatest public health benefit we can accomplish, as it will reduce premature death and enable patients to live longer free of the disabilities that target organ damage inflicts on the brain, heart, kidneys, and legs. Hypertension guidelines are an invaluable source of information on how to detect elevated BP, how to evaluate people for situations where hypertension is a symptom of other disorders, and how to apply the various treatments that lower BP effectively in patients. Determining the point at which treating high BP is more likely to result in benefit than harm is a marriage of science and art. There is no right answer to what clearly constitutes hypertension when using a systolic or diastolic BP to define it. The science shows the mathematics behind the reduction of BP and the number of lives saved and target organs preserved. The art comes into play when a decision is made that, when a systolic or diastolic BP exceeds a certain level, it becomes reasonable to intervene at that point with treatment. Caregivers play an important role in monitoring and educating patients with hypertension-especially in the detection of unintended effects of treatment, such as excessive BP lowering, symptomatic hypotension, and impacts on laboratory tests and well-being. Nonadherence to prescribed therapies is a barrier to effectively managing chronic disorders like hypertension. Having a solid foundation in the science behind the guidelines and recognizing that the application of guidelines requires some clinical judgment gleaned from balancing the risks and benefits of treatment in each individual patient, is the basis for healthy exchanges of ideas, like this pro and con series which discusses the science and furthers the art. This review has taken the con side of several issues in the latest American College of Cardiology/American Heart Association 2025 Hypertension Guideline.
高血压是全球最重要的非传染性疾病。发现并有效控制高血压是我们能实现的最大公共卫生效益，因为它将减少过早死亡，并使患者能够更长时间地生活，而不会出现因靶器官损害对大脑、心脏、肾脏和腿部造成的残疾。高血压指南是有关如何检测高血压、如何评估高血压作为其他疾病症状的情况以及如何在患者中有效应用各种降低血压治疗方法的宝贵信息来源。确定治疗高血压何时更可能带来益处而非危害是科学与艺术的结合。在使用收缩压或舒张压来定义高血压时，对于究竟什么明确构成高血压并没有正确答案。科学展示了降低血压背后的数学原理以及挽救的生命数量和保护的靶器官。当做出决定，即当收缩压或舒张压超过一定水平时，在此时进行治疗干预变得合理，艺术便发挥了作用。护理人员在监测和教育高血压患者方面发挥着重要作用，特别是在检测治疗的意外效果方面，例如血压过度降低、症状性低血压以及对实验室检查和健康状况的影响。不坚持规定的治疗方法是有效管理高血压等慢性疾病的障碍。在指南背后的科学方面有坚实的基础，并认识到指南的应用需要从平衡每个患者治疗的风险和益处中获得的一些临床判断，这是进行健康思想交流的基础，就像这个正反系列讨论科学并推动艺术发展一样。本综述探讨了美国心脏病学会/美国心脏协会2025年高血压指南中几个问题的反面观点。
