高血压诊断标准的变化与启示

Changes and enlightenment of diagnostic criteria for hypertension

高血压的诊断标准一直是学术界争议不断的话题。美国第一版高血压诊治指南(JNC1)于1977年问世,将血压高于160/95 mmHg(1 mmHg=0.133 kPa)的标准用来评估高血压。早期JNC系列指南对高血压的诊断标准和治疗目标相对模糊,且诊断中更重视舒张压指标。直到1997年的JNC6发布,首次将140/90 mmHg定义为高血压诊断标准。2017年美国高血压指南将高血压诊断标准改变为130/80 mmHg,这一改变引起了国内外的广泛争议。中国医师协会发布了中国医师协会关于我国高血压诊断标准及降压目标值的科学声明。美国新指南提出的标准虽然未得到其他国家指南的认同,但其对高血压防治战线要前移的理念得到了广泛的接受。

The definition of hypertension has been the object of controversy for many years. The First Report of the Joint National Committee( JNC-1) on Detection, Evaluation, and Treatment of High Blood Pressure was issued in 1977 and the levels of blood pressure above 160/95 mmHg was considered as high blood pressure(BP). The early JNC series guidelines are relatively vague on the diagnostic criteria and treatment goals of hypertension, and put more emphasis on diastolic blood pressure(DBP) in hypertension diagnosis. Since the publication of JNC VI reports, hypertension is defined as office systolic blood pressure(SBP) values≥140 mmHg and/or DBP values≥90 mmHg. The 2017 ACC/AHA Hypertension Guidelines changed the diagnostic criteria for hypertension by 130/80 mmHg and has caused widespread controversy at home and abroad. The Chinese Medical Doctor Association issued a scientific statement on the diagnostic criteria for hypertension and treatment targets of high BP in China. Although the standards proposed by the new ACC/AHA hypertension guideline is not recognized by other national guidelines, its concept of earlier prevention of hypertension has been widely accepted.