Simpson F O
University of Otago Medical School, Dunedin, New Zealand.
J Hypertens. 1996 Jun;14(6):683-9. doi: 10.1097/00004872-199606000-00002.
It has been suggested that selection for antihypertensive therapy should be based on absolute risk of a cardiovascular disease (CVD) event and that treatment should be offered only if the 10-year risk exceeds 20%. Although interesting and challenging, this strategy would have the effect of greatly emphasizing treatment of the elderly and downplaying treatment of the middle-aged. It is argued in this paper that the use of one and the same time-frame for all age groups is illogical; some inverse age-related adjustment is needed. In addition, it is suggested that selection for active treatment would be better based not on the total absolute risk of CVD but rather on the marginal hypertensive risk (i.e. that part of the total risk which can be attributed to raised blood pressure). Problems in the use of antihypertensive drugs in people with 'high normal' blood pressure in order to compensate for risk factors such as obesity, hyperlipidaemia and smoking are discussed. The effect of antihypertensive treatment administered in large-scale trials to the most hypertensive control subjects has been (and continues to be) largely ignored; it should be taken into account in all calculations in this field. A policy based on absolute risk is certainly worth examining but it should not be considered self-evidently correct and needs testing in all its aspects before it is adopted on a large scale.
有人建议，抗高血压治疗的选择应基于心血管疾病（CVD）事件的绝对风险，并且只有当10年风险超过20%时才应提供治疗。尽管这一策略有趣且具有挑战性，但它会极大地强调对老年人的治疗，而淡化对中年人的治疗。本文认为，对所有年龄组使用相同的时间框架是不合逻辑的；需要进行一些与年龄相关的反向调整。此外，有人建议，积极治疗的选择不应基于CVD的总绝对风险，而应基于边缘高血压风险（即总风险中可归因于血压升高的部分）。讨论了在血压“高正常”的人群中使用抗高血压药物以补偿肥胖、高脂血症和吸烟等风险因素的问题。在大规模试验中给予血压最高的对照组的抗高血压治疗效果（并且仍在很大程度上被忽视）；在该领域的所有计算中都应予以考虑。基于绝对风险的政策当然值得研究，但不应被视为不言而喻的正确，在大规模采用之前，需要对其所有方面进行测试。
