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成人高血压的概述

Authors
Jan Basile, MD
Michael J Bloch, MD, FACP, FASH, FSVM, FNLA
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc
Translators
刘莹, 主任医师，教授

引言

在美国，非妊娠成人到临床医生处就诊以及使用处方药的最常见原因就是治疗高血压[1]。从2005-2008年进行的美国国家健康和营养调查(National Health and Nutrition Examination Survey, NHANES)估计，在美国大约有29%-31%的成人患有高血压[1]。由这些数据可推测，20岁以上的美国人中约有7640万人患有高血压[2]。来自1999-2006年NHANES的数据提示多达8%的美国成年人有未诊断的高血压。

随着人口的老龄化，高血压患者数量很可能会增加，因为无论是单纯收缩期高血压还是收缩舒张双期高血压，均发生于大多数65岁以上的个体中(图 1)[3]。肥胖率不断增高，这也将会增加高血压患者的数量[3]。 (参见“老年患者高血压(特别是单纯收缩期高血压)的治疗”)

尽管高血压及其相关并发症的患病率较高，但对该病的控制却远远不够。尽管在过去的几十年里，对高血压的知晓率、治疗率和控制率已有所提高，但2005-2008年的NHANES数据显示，仅50.1%的高血压患者的血压得到了控制(定义为血压控制在140/90mmHg以下水平)(表 1)[4,5]。

高血压的控制率低还有大量潜在的原因，包括医疗保健服务和药品的易得程度较差，以及对通常无症状的疾病的长期治疗缺乏依从性[6]。当治疗可能影响患者的生活质量和治疗的即时获益对患者而言可能不明显时，缺乏长期治疗依从性的问题尤其突出。治疗惯性(therapeutic inertia)，定义为医疗保健提供者对已发现的血压控制不佳患者的治疗促进失败，治疗惯性也正成为提高控制率的一种公认障碍[7]。因此，高血压很可能仍然是心脏病发作和脑卒中最常见的危险因素[8]。 (参见“高血压的患者依从性和治疗”)

本专题对高血压的定义、发病机制、并发症、诊断、评估及治疗进行了广泛概述。上述所有问题的详细讨论见其他专题。在需要时，读者可被指引到其他专题获取有关这些问题更详细的讨论。

                                         

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Literature review current through: 2017-06 . | This topic last updated: 2016-03-02.
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