《中国高血压临床实践指南》(2022版)评价与中药降血压探索

Interpretation and review of Clinical Practice Guidelines for Management of Hypertension in China(2020 edition)and exploration of traditional Chinese medicine for antihypertensive treatment

高血压病是导致城乡居民心血管疾病死亡的最重要的危险因素,已成为全球重大公共卫生问题。2022年10月由国家心血管病中心等多个学术组织联合发布《中国高血压临床实践指南》(以下简称《实践指南》),明确下调高血压病诊断标准、提高老年患者降血压目标、提前药物干预时机的变化引发广泛讨论。虽然《实践指南》针对上述3个方面进行的调整具有一定的国际循证依据,然而就现有的证据水平,不同研究对强化降血压带来的心血管获益仍存在争议,同时此次提出的一系列新标准是否适合中国人群、我国基层高血压病控制水平能否适应新的诊治标准等方面,还有待进一步深入研究。不同于《实践指南》中血压严格达标等理念,中医学在治疗高血压病过程中,更强调包括高血压病前期、高血压病以及高血压病靶器官损害在内的全程防治与整体治疗观念。近年来,基于丰富的临床试验研究和高质量循证依据,中医药治疗高血压病的优势逐渐显现。团队前期研究发现,高血压病的病机包括火证、饮证、虚证三大类型。中医药治疗高血压病具有平稳降血压、缓和降血压、持久降血压特征。在降血压之外,还具有逆转危险因素、保护靶器官损伤等作用,体现出多靶点、多成分、整体综合调节特点,可运用于包括高血压病前期、高血压病以及高血压病靶器官损害的高血压病前期、中期与晚期的全过程防治,具有一定的临床应用前景。

Hypertension is the most important risk factor for cardiovascular disease-related deaths among urban and rural residents,and it has become a significant global public health issue.In October 2022,the Clinical Practice Guidelines for the Management of Hypertension in China(hereinafter referred to as the Practice Guidelines)were jointly released by the National Cardiovascular Center and other academic organizations.The Practice Guidelines sparked extensive discussions as they clearly lowered the diagnostic criteria for hypertension,raised the blood pressure targets for elderly patients,and proposed changes in the timing of early medication intervention.While these adjustments have some international evidence-based support,there is still debate regarding the cardiovascular benefits of intensified blood pressure control based on the existing level of evidence.Furthermore,whether the series of new standards proposed in the Practice Guidelines are suitable for the Chinese population and whether the hypertension control level in primary care in China can adapt to the new diagnostic and treatment standards require further in-depth research.In contrast to the strict blood pressure control concept emphasized in the Practice Guidelines,traditional Chinese medicine(TCM)emphasizes the concept of comprehensive prevention and treatment and holistic therapy in the treatment of hypertension,including prehypertension,hypertension,and target organ damage.In recent years,based on abundant clinical trial research and high-quality evidence-based support,the advantages of TCM in treating hypertension have gradually emerged.Previous studies by this research team have found that the pathogenesis of hypertension includes three major types:fire syndrome,fluid retention syndrome,and deficiency syndrome.TCM treatment of hypertension features stable blood pressure reduction,gentle blood pressure lowering,and long-lasting effects.In addition to blood pressure reduction,it also has effects such as reversing risk factors and protecting target organ damage.It demonstrates the characteristics of multiple targets,multiple components,and comprehensive regulation,and can be applied throughout the entire process of prevention and treatment,including prehypertension,hypertension,and target organ damage in the early,middle,and late stages of hypertension.Therefore,it has certain clinical application prospects.