《美国医学会杂志》(JAMA)发表的《2014 成人高血压管理指南》(JNC8),提出了九项推荐意见,解答了三个问题:何时开始降压? 降压的目标值? 用什么药降压? 何时开始降压和降压的目标值是一致的:≥60 岁的老年人,血压应控制在150/90 mmHg 以内;＜60 岁的患者或合并糖尿病或慢性肾脏病,血压应控制在140/90 mmHg 以内;超过上述界限应开始降压。 合并肾脏病的高血压患者,降压药首选血管紧张素转换酶抑制剂(ACEI)或者血管紧张素受体阻滞剂(ARB)(两者不宜联合使用),也可选用噻嗪类利尿剂和钙通道阻滞剂(CCB);对于其他非黑人高血压患者,上述4 种药物均为一线降压药物。 当一个降压药不能将血压降至目标值时,可以加量也可以联合其他降压药。

The “2014 Evidence-Based Guideline for the Management of High Blood Pressure (BP) in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC8)” published in the Journal of the American Medical Association (JAMA), has made nine recommendations, and answered three questions: when to initiate antihypertensive pharmacologic therapy? What's the specified BP goal of treatment with the antihypertensive pharmacologic therapy? What drugs should be used for the treatment from the various antihypertensive drugs or drug classes? When to initiate antihypertensive therapy is consistent with the goal of antihypertensive therapy. In the general population aged ≥60 years, initiate pharmacologic treatment to lower BP at ≥150/90 mmHg to a goal BP ＜150/90 mmHg. In the population aged ＜60 years,with or without chronic kidney disease (CKD)/diabetes, initiate pharmacologic treatment to lower BP at ≥140/90 mmHg to a goal BP ＜140/90 mmHg. In hypertensive patients complicated with CKD, initial antihypertensive treatment should include an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (the two should not be used in combination) to improve kidney outcomes,although a thiazide-type diuretic, or calcium channel blocker (CCB) can also be included. For other non-black patients with hypertension, each of the above four classes (thiazide-type diuretic, CCB, ACEI, or ARB) can be used as the first-line antihypertensive drugs. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add more drugs from the four classes mentioned above.