从循证医学证据看收缩期高血压诊治的现状

Status on Diagnosis and Treatment of Systolic Hypertension from Evidence-Based Medicine

采用美国国立医学图书馆的Medline数据库检索英文文献，特另U强调随机临床试验。结果在SHEP、Syst-Eur、Syst-China这3个一级终点设计的收缩期高血压临床试验中，收缩压入选标准≥160mmHg、降压目标〈150mmHg，所选用降压药为利尿剂和钙拮抗剂。而收缩压在140—159mmHg的收缩期高血压病人缺乏大规模临床试验证据，证据主要来源于观察性研究，在这些观察性研究中，心血管危险随着收缩压升高而升高。在收缩期高血压病人中，收缩压≥160mmHg开始治疗，降压目标〈150mmHg具有很强的证据。而收缩压在140～159mmHg治疗，降压目标〈140mmHg证据强度较弱。

A Medline search of English-language literature was performed to identify reports about systolic hypertension（SH） ,with particular emphasis on data from randomized clinical trials. As a result,in SHEP, Syst- Eur, Syst-China randomized clinical trails about SH, the definition of SH is systolic blood pressure （SBP） ≥ 160mmHg,and the goal of SBP reduction is 〈 150mmHg,with the use of thiazide diuretics and channel blockers. Large-scale trials to assess the value of antihypertensive therapy for patients whose SBP is 140 - 159mmHg have not been performed, and recommendations to treat these patients are based on observational studies, in which it shows that cardiovascular risk increases along with the increase of SBP. It is supported by strong evidence that treatment of SH begins in the patients with SBP ≥ 160mmHg and the goal of SBP reduction is 〈 150mmHg. It is weakly supported to treat the patients with SBP 140 - 159mmHg and to get the goal of SBP 〈 140mmHg.