Schrader J
Medizinischen Klinik, St.-Josefs-Hospital, Cloppenburg.
Fortschr Med. 1997 Oct 10;115(28):26, 29-30, 33-4.
In younger and middle-aged patients treatment should lower the blood pressure to below 140/90 mmHg and in the elderly aged 65 and more to 160/90 mmHg. Numerous interventional studies have shown that this can appreciably reduce the complications of hypertension. However, account must always be taken of the individual risk, so that in a particular case, it might be desirable to aim for lower values, for example, in diabetic nephropathy or when there is a summation of risks. The question as to whether there is a "point of reversal", that is, a renewed increase in complications associated with too great lowering of the blood pressure is still controversial. What is certain is that a lowering of blood pressure that is too rapid and too great can harm the patient with coronary or cerebral vascular stenoses. Better control of the blood pressure is enabled by the 24-hour blood pressure measurement by recording "office hypertension" or "office normotension", intermittent hypertensive or hypotensive phases and, in particular the nocturnal course of the blood pressure (no physiological dip/too pronounced dip).
对于中青年患者，治疗应将血压降至140/90 mmHg以下，对于65岁及以上的老年人，应降至160/90 mmHg。大量干预性研究表明，这可以显著降低高血压的并发症。然而，必须始终考虑个体风险，因此在特定情况下，可能需要设定更低的目标值，例如在糖尿病肾病或存在风险叠加时。关于是否存在“逆转点”，即血压降得过低会再次增加并发症的问题仍存在争议。可以确定的是，血压下降过快、幅度过大可能会对患有冠状动脉或脑血管狭窄的患者造成伤害。通过24小时血压测量记录“诊室高血压”或“诊室血压正常”、间歇性高血压或低血压阶段，尤其是夜间血压变化情况（无生理性血压下降/血压下降过于明显），能够更好地控制血压。
