Cardioprotection and antihypertensive therapy: The key importance of addressing the associated coronary risk factors - (The Framingham Experience)
Cardioprotection and antihypertensive therapy: The key importance of addressing the associated coronary risk factors - (The Framingham Experience)
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DOI：
10.1016/s0002-9149(97)89232-6
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发表时间：
1996-02-22
影响因子：
2.8
通讯作者：
Kannel, WB
中科院分区：
文献类型：
--
作者：
Kannel, WB
高血压直接诱发所有主要动脉粥样硬化性心血管疾病的结果，包括冠状动脉疾病、中风、心力衰竭和外周动脉疾病。冠状动脉疾病在高血压治疗中应得到高度重视，因为它是最常见和致命的后遗症。然而，将降低血压作为抗高血压治疗的唯一治疗目标已不再合适。高血压往往与其他致动脉粥样硬化的危险因素聚集在一起，包括血脂异常、葡萄糖耐受不良、胰岛素抵抗、肥胖和尿酸升高。高血压只是动脉粥样硬化性心血管疾病的众多危险因素之一，其危险程度也各不相同，具体取决于这些共存的代谢相关危险因素的数量和严重程度。共存的、已经明显的心血管疾病和左心室肥厚也极大地影响了治疗的风险和选择。治疗的紧迫性和选择应基于多变量心血管风险状况，而不是仅仅依赖于血压升高的特征和严重程度。通过这种方式，可以更适当地针对高危高血压患者进行旨在改善其多变量风险状况并提供最大效益和成本效益的治疗。
Hypertension directly predisposes to all of the major atherosclerotic cardiovascular disease outcomes, including coronary artery disease, stroke, cardiac failure, and peripheral artery disease. Coronary artery disease deserves a high priority in treatment of hypertension because it is the most common and lethal sequela. However, reduction of blood pressure as the sole therapeutic goal of antihypertensive therapy is no longer appropriate. Hypertension tends to cluster with other atherogenic risk factors, including dyslipidemia, glucose intolerance, insulin resistance, obesity, and elevated uric acid. Hypertension is only one of the many risk factors for atherosclerotic cardiovascular disease and is variably hazardous, depending on the number and severity of these coexistent metabolically linked risk factors. The presence of coexistent, already overt cardiovascular disease and left ventricular hypertrophy also greatly influence the hazard and choice of therapy. The urgency for, and choice of, therapy should be based on the multivariate cardiovascular risk profile rather than relying solely on the character and severity of the blood pressure elevation. In this way at-risk hypertensive persons can be more appropriately targeted for treatment designed to improve their multivariate risk profile and to provide maximum benefit and cost effectiveness.