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高血压：谁应该进行治疗？

Authors
Johannes FE Mann, MD
Karl F Hilgers, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc
Translators
李康, 副主任医师

引言

高血压的治疗通常以非药物治疗开始，包括适当的膳食钠限制、肥胖者减轻体重、避免过度饮酒和规律的有氧运动(表 1)[1,2]。采取这些措施对患者几乎不会甚至完全不会带来风险，从一般健康的观点来看，这些措施可能均是有益的，即使是对于血压正常的个体也是如此。 (参见“饮食对高血压预防和治疗的作用”)

相比之下，药物治疗可能花费高而且常伴有副作用，而部分副作用(低钾血症和高脂血症)可能实际上会增加冠状动脉疾病风险。 (参见“低钾血症的原因”，关于‘利尿剂’一节和“抗高血压药物和脂质”)

因此，在开始使用降压药物之前，必须有明确的证据表明极可能获益。大多数不同程度的高血压有可用的此类证据(60岁以下的患者收缩压≥140mmHg；80岁及以上的患者收缩压≥150mmHg，以及任何年龄的患者舒张压持续≥90mmHg)[1,3,4]。

表明对不同程度高血压的治疗是有益的证据，以及对哪些人群应该进行治疗的推荐将总结在此。高血压治疗的概述、初始治疗降压药物的选择、目标血压值将单独讨论。 (参见“成人高血压的概述”，关于‘治疗’一节和“原发性高血压的药物治疗选择”和“高血压治疗中目标血压应该是多少”)

定义

主要学会已发布了高血压的定义[5-7]。一般而言，高血压定义为收缩压大于等于140mmHg/舒张压大于等于90mmHg。然而，后来的试验表明：较高风险患者群体中，目标血压低于此水平可能与结局改善有关。 (参见下文‘目标血压’)

            

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-29.
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