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。

原发性高血压被定义为血压≥140/90 mmHg，但没有发现继发性原因。[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]James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20. https://jamanetwork.com/journals/jama/fullarticle/1791497 http://www.ncbi.nlm.nih.gov/pubmed/24352797?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

第 8 届美国预防、检测、评估和治疗高血压委员会 (Eighth Joint National Committee, JNC8) 指南建议，血压≥140/90 mmHg 的慢性肾脏病和糖尿病患者应该开始药物治疗。[3]James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20. https://jamanetwork.com/journals/jama/fullarticle/1791497 http://www.ncbi.nlm.nih.gov/pubmed/24352797?tool=bestpractice.com 对于年龄≥60 岁的普通人群，如果血压 (BP)≥150/90 mmHg 时，应开始降压治疗。但因为对于 BP≥140/90 mmHg 的心血管事件相关风险看法不同，专家组成员并没有在此条建议达成一致。

在 2018 年欧洲心脏病学会 (European Society of Cardiology, ESC) 和欧洲高血压学会 (European Society of Hypertension, ESH) 指南中，高血压被定义为诊室收缩压≥140 mmHg和/或舒张压≥ 90 mmHg，这就相当于 24 小时活动性血压检测值平均≥130/80mmHg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

根据新的证据，血压目标和建议在不断更新。

2017 年美国心脏病学会/美国心脏协会 (American College of Cardiology/American Heart Association, ACC/AHA) 指南将高血压定义为收缩压检测值≥130mmHg或舒张压检测值≥80 mmHg。[5]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 此定义有别于 JNC 8、ESH 和 ESC 指南中的定义。

收缩压干预试验 (Systolic Blood Pressure Intervention Trial, SPRINT) 发现，在年龄大于 50 岁、罹患高血压且至少有一种其他心脏病危险因素的人群中，120 mmHg（采用自动化诊室血压测量）这一较低的收缩压目标可减少心血管并发症和死亡。[6]The SPRINT Study Research Group. Systolic Blood Pressure Intervention Trial. 2016 [internet publication]. https://www.sprinttrial.org/public/dspHome.cfm [7]Wright JT Jr, Williamson JD, Whelton PK, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood pressure control. N Engl J Med. 2015 Nov 26;373(22):2103-16. https://www.nejm.org/doi/10.1056/NEJMoa1511939 http://www.ncbi.nlm.nih.gov/pubmed/26551272?tool=bestpractice.com 这项临床试验排除了糖尿病或卒中患者。