JNC7(美国最新高血压治疗指南)

ISSN:1524-4563Copyright©2003AmericanHeartAssociation.Allrightsreserved.PrintISSN:0194-911X.Online72514HypertensionispublishedbytheAmericanHeartAssociation.7272GreenvilleAvenue,Dallas,TXDOI: 10.1161/01.HYP.0000107251.49515.c22003;42;1206-1252;originallypublishedonlineDec1,2003;HypertensionEducationProgramCoordinatingCommitteeJacksonT.Wright,Jr,EdwardJ.RoccellaandtheNationalHighBloodPressureGreen,JosephL.Izzo,Jr,DanielW.Jones,BarryJ.Materson,SuzanneOparil,AramV.Chobanian,GeorgeL.Bakris,HenryR.Black,WilliamC.Cushman,LeeA.Evaluation,andTreatmentofHighBloodPressureSeventhReportoftheJointNationalCommitteeonPrevention,Detection,:Theonlineversionofthisarticle,alongwithupdatedinformationandservices,is:Informationaboutreprintscanbefoundonlineat [e-mail]410-528-8550.E-mail:Fax:KluwerHealth,351WestCamdenStreet,Baltimore,MD21202-2436.Phone:[phone].Permissions:Permissions&RightsDesk,LippincottWilliams&Wilkins,adivisionofWolters :InformationaboutsubscribingtoHypertensionisonlineatatVAMEDCTRBOISEonNovember6,2009hyper.ahajournals.orgDownloadedfromSEVENTHREPORTOFTHEJOINTNATIONALCOMMITTEEONPREVENTION,DETECTION,EVALUATION,ANDTREATMENTOFHIGHBLOODPRESSUREAramV.Chobanian,GeorgeL.Bakris,HenryR.Black,WilliamC.Cushman,LeeA.Green,JosephL.Izzo,Jr,DanielW.Jones,BarryJ.Materson,SuzanneOparil,JacksonT.Wright,Jr,EdwardJ.Roccella,andtheNationalHighBloodPressureEducationProgramCoordinatingCommitteeAbstract—TheNationalHighBloodPressureEducationProgrampresentsthecompleteSeventhReportoftheJointNationalCommitteeonPrevention,Detection,Evaluation,andTreatmentofHighBloodPressure.Likeitspredecessors,thepurposeistoprovideanevidence-basedapproachtothepreventionandmanagementofhypertension.Thekeymessagesofthisreportarethese:inthoseolderthanage50,systolicbloodpressure(BP)ofgreaterthan140mmHgisamoreimportantcardiovasculardisease(CVD)riskfactorthandiastolicBP;beginningat115/75mmHg,CVDriskdoublesforeachincrementof20/10mmHg;thosewhoarenormotensiveat55yearsofagewillhavea90%lifetimeriskofdevelopinghypertension;prehypertensiveindividuals(systolicBP120–139mmHgordiastolicBP80–89mmHg)requirehealth-promotinglifestylemodificationstopreventtheprogressiveriseinbloodpressureandCVD;foruncomplicatedhypertension,thiazidediureticshouldbeusedindrugtreatmentformost,eitheraloneorcombinedwithdrugsfromotherclasses;thisreportdelineatesspecifichigh-riskconditionsthatarecompellingindicationsfortheuseofotherantihypertensivedrugclasses(angiotensin-convertingenzymeinhibitors,angiotensin-receptorblockers,beta-blockers,calciumchannelblockers);twoormoreantihypertensivemedicationswillberequiredtoachievegoalBP(
140/90mmHg,or
130/80mmHg)forpatientswithdiabetesandchronickidneydisease;forpatientswhoseBPismorethan20mmHgabovethesystolicBPgoalormorethan10mmHgabovethediastolicBPgoal,initiationoftherapyusingtwoagents,oneofwhichusuallywillbeathiazidediuretic,shouldbeconsidered;regardlessoftherapyorcare,hypertensionwillbecontrolledonlyifpatientsaremotivatedtostayontheirtreatmentplan.Positiveexperiences,trustintheclinician,andempathyimprovepatientmotivationandsatisfaction.Thisreportservesasaguide,andthecommitteecontinuestorecognizethattheresponsiblephysician’sjudgmentremainsparamount.(Hypertension.2003;42:1206–1252.)Formorethan3decades,theNationalHeart,Lung,andBloodInstitute(NHLBI)hasadministeredtheNationalHighBloodPressureEducationProgram(NHBPEP)Coordi-natingCommittee,acoalitionof39majorprofessional,public,andvoluntaryorganizationsand7federalagencies.Oneimportantfunctionistoissueguidelinesandadvisoriesdesignedtoincreaseawareness,prevention,treatment,andcontrolofhypertension(highbloodpressure).DatafromtheNationalHealthandNutritionExaminationSurvey(NHANES)haveindicatedthat50millionormoreAmericanshavehighbloodpressure(BP)warrantingsomeformoftreatment.1,2Worldwideprevalenceestimatesforhypertensionmaybeasmuchas1billionindividuals,andapproximately7.1milliondeathsperyearmaybeattributabletohypertension.3TheWorldHealthOrganizationreportsthatsuboptimalBP(115mmHgSBP)isresponsiblefor62%ofcerebrovasculardiseaseand49%ofischemicheartdisease,withlittlevariationbysex.Inaddition,suboptimalbloodpressureisthenumberoneattributableriskfordeaththrough-outtheworld.3Considerablesuccesshasbeenachievedinthepastinmeetingthegoalsoftheprogram.Theawarenessofhyper-tensionhasimprovedfromalevelof51%ofAmericansintheperiod1976to1980to70%in1999to2000(Table1).TheReceivedNovember5,2003;revisionacceptedNovember6,2003.FromBostonUniversitySchoolofMedicine(A.V.C.),Boston,Mass;RushUniversityMedicalCenter(G.L.B.,H.R.B.),Chicago,Ill;VeteransAffairsMedicalCenter(W.C.C.),Memphis,Tenn;UniversityofMichigan(L.A.G.),AnnArbor,Mich;StateUniversityofNewYorkatBuffaloSchoolofMedicine(J.L.I.Jr.),Buffalo,NY;UniversityofMississippiMedicalCenter(D.W.J.),Jackson,Miss;UniversityofMiami(B.J.M.),Miami,Fla;UniversityofAlabamaatBirmingham(S.O.),Birmingham,Ala;CaseWestern