Himmelmann A, Hedner T, Hansson L, O'Donnell C J, Levy D
Department of Clinical Pharmacology, Sahlgrenska University Hospital, Göteborg, Sweden.
Blood Press. 1998 Jul;7(4):197-207. doi: 10.1080/080370598437222.
Hypertension is an established risk factor for cardiovascular disease morbidity and mortality. Randomized trials of antihypertensive therapy have demonstrated the benefits of treating diastolic blood pressure, and recently the value of treating isolated systolic blood pressure has also been established. There is an excess risk of cardiovascular disease in subjects with borderline isolated systolic hypertension. In fact, data from men screened for the Multiple Risk Factor Intervention Trial show that the great majority of excess deaths are in those with high-normal systolic blood pressure or with stage 1 hypertension, i.e., systolic blood pressure 130 to 159 mmHg. Similarly, data from the Framingham Heart Study and the Physicians' Health Study emphasize the importance of mild elevations of systolic blood pressure. As age increases the hemodynamic patterns of blood pressure change due to an increase in large artery stiffness, and borderline isolated systolic hypertension becomes the dominant form of hypertension. These facts make the prevention and control of borderline isolated systolic hypertension a key strategic challenge in the effort to prevent excess mortality attributable to blood pressure levels above normal.
高血压是心血管疾病发病和死亡的既定危险因素。抗高血压治疗的随机试验已证明治疗舒张压的益处，最近治疗单纯收缩期高血压的价值也已得到确立。临界单纯收缩期高血压患者存在心血管疾病额外风险。事实上，来自多重危险因素干预试验筛查男性的数据表明，绝大多数额外死亡发生在收缩压高正常或1期高血压患者中，即收缩压为130至159 mmHg。同样，弗明汉心脏研究和医生健康研究的数据强调了收缩压轻度升高的重要性。随着年龄增长，由于大动脉僵硬度增加，血压的血流动力学模式发生变化，临界单纯收缩期高血压成为高血压的主要形式。这些事实使得预防和控制临界单纯收缩期高血压成为预防因血压水平高于正常导致额外死亡的关键战略挑战。
