原发性高血压

通常通过对无症状患者筛查，进行原发性高血压诊断。

积极治疗未控制高血压能够降低死亡风险，同时能够减少心脏并发症、血管并发症、肾脏病并发症和脑血管并发症的风险。

推荐所有患者改变生活方式：减重、锻炼、减少钠的摄入量、高血压膳食疗法 (Dietary Approaches to Stop Hypertension, DASH) 和饮酒适度。

药物治疗选择需要考虑与之相关的合并疾病，血压达标可能需要多种药物联合治疗。

原发性高血压定义为血压（blood pressure, BP）持续升高且无继发性原因。[1]National Heart, Lung, and Blood Institute. The seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Aug 2004 [internet publication]. https://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf [2]Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104. https://academic.oup.com/eurheartj/article/39/33/3021/5079119 http://www.ncbi.nlm.nih.gov/pubmed/30165516?tool=bestpractice.com [3]Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248. https://www.jacc.org/doi/full/10.1016/j.jacc.2017.11.006 http://www.ncbi.nlm.nih.gov/pubmed/29146535?tool=bestpractice.com ​ 治疗的主要目标是降低死亡风险以及心血管和肾脏并发症的发病风险。[4]Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet. 1998 Jun 13;351(9118):1755-62. http://www.ncbi.nlm.nih.gov/pubmed/9635947?tool=bestpractice.com

美国心脏病学会（American College of Cardiology, ACC）/美国心脏协会（American Heart Association, AHA）指南将高血压定义为收缩压检测值≥130 mmHg 或舒张压检测值≥80 mmHg。[3]Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248. https://www.jacc.org/doi/full/10.1016/j.jacc.2017.11.006 http://www.ncbi.nlm.nih.gov/pubmed/29146535?tool=bestpractice.com

欧洲心脏病学会（European Society of Cardiology, ESC）和欧洲高血压学会（European Society of Hypertension, ESH）指南将高血压定义为诊室（门诊）收缩压≥140 mmHg 和/或舒张压≥90 mmHg，相当于 24 小时动态血压检测值平均≥130/80 mmHg，或者家庭血压检测值平均≥135/85 mmHg。[2]Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104. https://academic.oup.com/eurheartj/article/39/33/3021/5079119 http://www.ncbi.nlm.nih.gov/pubmed/30165516?tool=bestpractice.com [5]Mancia G, Kreutz R, Brunström M, et al. 2023 ESH guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023 Jun 21. https://journals.lww.com/jhypertension/fulltext/9900/2023_esh_guidelines_for_the_management_of_arterial.271.aspx http://www.ncbi.nlm.nih.gov/pubmed/37345492?tool=bestpractice.com

世界卫生组织（World Health Organization, WHO）建议对确诊为高血压并且收缩压≥140 mmHg 或舒张压≥90 mmHg 的患者开始进行药物降压治疗。[6]World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. Aug 2021 [internet publication]. https://www.who.int/publications/i/item/9789240033986

血压的目标值和建议值随着新证据的出现而不断更新。