Alderman M H
Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, N.Y. 10461, USA.
Am Heart J. 1998 Feb;135(2 Pt 2):S8-15. doi: 10.1016/s0002-8703(98)70308-4.
The fifth report of the National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) has weathered the test of time fairly well. The significant new dimensions of the 1992 document included (1) a new classification system reflecting the recognition that risk from hypertension does not arise at a specific blood pressure level but is continuous, (2) an expanded list of agents suitable for antihypertensive therapy, (3) recognition of the significance of systolic blood pressure as a risk factor, particularly isolated systolic blood pressure in the elderly, (4) identification of diuretics and beta-blockers as agents of first use, and (5) recognition that, in addition to level of blood pressure, absolute risk for cardiovascular disease events should influence the nature of therapy. Concern for matching therapeutic efforts with actual risk of disease and potential for benefit has grown. Some have recommended that drug therapy be reserved for those whose absolute risk of a CVD event is above an arbitrary threshold. The next JNC report is likely to be more precise in linking treatment recommendations to the actual level of risk, as well as level of blood pressure, particularly within the broad range of levels where, in JNC V, the decision to treat was left to individual judgment.
美国国家高血压检测、评估与治疗委员会第五次报告（JNC V）经受住了时间的考验。1992年这份文件的重要新内容包括：（1）一种新的分类系统，反映出人们认识到高血压风险并非在特定血压水平出现，而是持续存在的；（2）适用于抗高血压治疗的药物清单有所扩充；（3）认识到收缩压作为风险因素的重要性，尤其是老年人的单纯收缩期高血压；（4）确定利尿剂和β受体阻滞剂为首选药物；（5）认识到除血压水平外，心血管疾病事件的绝对风险也应影响治疗性质。人们越来越关注使治疗措施与疾病的实际风险和获益潜力相匹配。一些人建议，药物治疗应仅用于心血管疾病事件绝对风险高于某个任意阈值的人群。预计下一份JNC报告在将治疗建议与实际风险水平以及血压水平相联系时会更加精确，尤其是在JNC V中治疗决策留给个人判断的广泛血压水平范围内。
