Hennekens C H
Harvard Medical School and the Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215-1204, USA.
Am J Med. 1998 Jun 22;104(6A):50S-53S. doi: 10.1016/s0002-9343(98)00188-0.
Hypertension is a well-established risk factor for stroke, myocardial infarction (MI), and premature cardiovascular death. Even mild elevations of blood pressure (i.e., diastolic blood pressure >90 and <110 mm Hg) yield increased risk. In fact, mild-to-moderate hypertension is more common than severe hypertension and accounts for a greater proportion of the deaths and serious nonfatal vascular events. The treatment goal is to make optimal use of antihypertensive drug therapy while encouraging patients to implement lifestyle changes such as weight loss, sodium restriction, decreased alcohol intake, and increased exercise. Pharmacologic therapy of mild-to-moderate hypertension can significantly reduce the incidence of stroke, MI, coronary artery disease, vascular mortality, and total mortality. Beta blockers and diuretics should continue to be used as first-line therapy until there is direct and reliable evidence from large-scale randomized trials with clinical endpoints for newer agents such as calcium antagonists and angiotensin-converting enzyme inhibitors.
高血压是中风、心肌梗死（MI）和心血管疾病过早死亡的一个公认的危险因素。即使血压轻度升高（即舒张压>90且<110 mmHg）也会增加风险。事实上，轻度至中度高血压比重度高血压更常见，并且在死亡和严重非致命性血管事件中所占比例更大。治疗目标是在鼓励患者进行生活方式改变（如减肥、限制钠摄入、减少酒精摄入和增加运动）的同时，优化使用抗高血压药物治疗。轻度至中度高血压的药物治疗可显著降低中风、心肌梗死、冠状动脉疾病、血管死亡率和总死亡率。在有来自以临床终点为指标的大规模随机试验的直接可靠证据证明新型药物（如钙拮抗剂和血管紧张素转换酶抑制剂）优于β受体阻滞剂和利尿剂之前，β受体阻滞剂和利尿剂应继续作为一线治疗药物。
