特别提示：本文仅用于学术讨论，不作为临床指导。临床上应根据我国现行高血压指南进行血压管理。

        关于高血压患者降压目标值问题一直存在一些争议。我国现行高血压指南建议如下：一般高血压患者<140/90 mmHg，65岁及以上老年人收缩压<150 mmHg，伴188bet在线平台网址 、慢性肾病、稳定性冠心病患者<130/80 mmHg。对于这一问题，不同国家或地区的指南所做出的推荐建议不尽相同。指南中关于降压目标值的推荐主要依据是随机化临床试验，由于临床试验不可能涵盖各种基线特征的人群，所以在确定不同人群目标值时既要参照现有临床研究证据，又要考虑到流行病学研究结论，并以此为基础形成专家共识。

        近日，美国波士顿大学医学中心Chobanian教授对此阐述了自己的观点(JAMA. Published online January 30, 2017. doi:10.1001/jama.2017.0105)，其要点如下：

        1. 一般人群：50岁以下患者<120/80 mmHg;50-74岁患者收缩压<130 mmHg;75岁及以上患者收缩压<140 mmHg，若耐受良好可降至<130 mmHg。

        2. 高危人群(确诊心血管疾病或心血管病风险增高者、慢性肾病、188bet在线平台网址 )：50岁以下患者<130 mmHg;50-74岁心血管病或慢性肾病患者收缩压<130 mmHg、2型188bet在线平台网址 患者收缩压<140 mmHg(若耐受良好可降至<130 mmHg);75岁及以上患者收缩压<140 mmHg，若耐受良好可降至<130 mmHg。(见附表)

        虽然国内外各种指南中均会对不同类别患者的血压控制目标做出相应的推荐建议，但在临床实践中需要遵循个体化的原则：在患者耐受性良好、无不良反应且不需要太多药物的情况下，血压可以控制到较低水平，反之则应适当放宽血压控制目标。

        附上原文，有兴趣的朋友可以进一步了解该作者对上述目标值的解释。

        Suggested Blood Pressure Goals for Treatment of Hypertension

        First, for most adults younger than 50 years, despite the lack of definitive clinical trial data, the goal BP of less than 120/80 mm Hg is recommended based on the wealth of epidemiological data demonstrating an almost linear increase in CVD risk with increasing BP levels above this goal. In the presence of CVD, chronic renal disease, or diabetes, an SBP goal of less than 130 mm Hg seems appropriate. Since the majority of young persons with hypertension have stage 1 hypertension, lifestyle measures should be used initially in most before initiating medications.

        Second, for individuals between 50 and 74 years old, a long-term SBP goal of less than 130 mm Hg is appropriate for most patients. However, because of some uncertainties, it would be prudent to first achieve a target of less than 140 mm Hg, and then if treatment to that target is well tolerated, proceed to the lower goal. This approach is recommended irrespective of the presence or absence of CVD or chronic kidney disease. In individuals with type 2 diabetes, the long-term target currently should be an SBP level of less than 140 mm Hg, although a somewhat lower target might be considered in view of the observed benefit of reducing stroke incidence with intensive therapy in ACCORD.

        Third, for persons aged 75 years or older, more than 75% of whom have hypertension, reduction of SBP is clearly beneficial, but the exact SBP goal is still unclear. At present, a goal of less than 140 mm Hg appears reasonable but should be achieved by careful titration of medications and monitoring for orthostatic hypotension and changes in renal function and cognition. For individuals who tolerate treatment well, further efforts might be made to reach a target of less than 130 mm Hg, but this may occur in a minority of patients.

        The ultimate goal should be to prevent hypertension. Efforts should be intensified rather than simply acknowledged. For persons with prehypertension, particularly with BP levels in the 130-139/85-89 mm Hg range, adoption of healthy lifestyles should be stressed by clinicians to their patients. In addition, use of statins and efforts to stop smoking should be considered in all persons with hypertension to reduce cardiovascular complications.