Jackson R, Barham P, Bills J, Birch T, McLennan L, MacMahon S, Maling T
Department of Community Health, University of Auckland, New Zealand.
BMJ. 1993 Jul 10;307(6896):107-10. doi: 10.1136/bmj.307.6896.107.
A report to the National Advisory Committee on Core Health and Disability Support Services, New Zealand, on the management of raised blood pressure recommends that decisions to treat raised blood pressure should be based primarily on the estimated absolute risk of cardiovascular disease rather than on blood pressure alone. In general, patients with a blood pressure of 150-170 mm Hg systolic or 90-100 mm Hg diastolic, or both, should be given treatment to lower blood pressure if the risk of a major cardiovascular disease event in 10 years is more than about 20%. The results of clinical trials indicate that, at this level of absolute risk, 150 people would require treatment to reduce the annual number of cardiovascular events by about one. Implementation of these recommendations may result in a smaller proportion of people aged under 60, particularly women, receiving treatment but an increased proportion of older people treated. In the absence of specific contraindications, low dose diuretics and low dose beta blockers should be considered for first line treatment, since for only these drug groups is there direct evidence of reduced risk of stroke and coronary disease in people with raised blood pressure.
一份提交给新西兰国家核心健康与残疾支持服务咨询委员会的关于高血压管理的报告建议，治疗高血压的决策应主要基于心血管疾病的估计绝对风险，而非仅依据血压。一般而言，如果10年内发生重大心血管疾病事件的风险超过约20%，收缩压为150 - 170毫米汞柱或舒张压为90 - 100毫米汞柱，或两者皆有的患者，应接受降压治疗。临床试验结果表明，在此绝对风险水平下，需要150人接受治疗才能使每年心血管事件数量减少约一例。实施这些建议可能导致60岁以下人群，尤其是女性接受治疗的比例降低，但接受治疗的老年人比例增加。在没有特定禁忌证的情况下，应考虑将低剂量利尿剂和低剂量β受体阻滞剂作为一线治疗药物，因为只有这两类药物有直接证据表明可降低高血压患者中风和冠心病的风险。
