◆New Blood Pressure Classification Questioned JNC 7将收缩压在120-130 mmHg或舒张压在80-89mmHg定义为"高血压前期"，这与之前一致认可的高血压分期似乎相去甚远。因为本来"非病"，而现在"是病"，这一举措无疑会提高医生及患者对疾病的警剔性，对心血管疾病的发展会起到预防作用，也许还可能推动社会经济的发展。但是，医生将如何减轻人们的焦虑和即将面对占人口数50%的新增患者，也是有待解决的问题。 Many of the ASH delegates commented on the major step that JNC 7 appears to have taken away from the previous consensus on how to classify hypertension. Leading off the critique, Jay N Cohn, MD (University of Minnesota Medical School, Minneapolis), expressed his delight with the report's emphasis on the "high normal" blood pressure group (now classified as "prehypertensive"), because most cardiovascular morbid events occur in that group. Like others, however, he was troubled by the term "prehypertension." He believes that this new category will simply create anxiety in the general population. He pointed out that not all people in the new class are at risk for subsequent development of high blood pressure or for cardiovascular morbid events, which should be the focus of therapeutic efforts. As a result, Dr Cohn believes that a potential problem has been introduced, with physicians now having to deal with almost 50% of the overall population. Dr. Chobanian replied that a lot of discussion took place before the term "prehypertension" was chosen. Ultimately it was deemed by the JNC 7 executive committee and others to be a more "action-oriented" term than "high normal," based partly on focus group investigations with doctors who said that the term "prediabetic" or "precancerous" resulted in patient responses, but the term "high normal" was ignored. Another widely expressed concern about the new term was its potential socioeconomic implications, resulting from application of the label "prehypertensive" to individuals previously considered normotensive. Dr. Chobanian agreed that the committee had been concerned about this and had contacted and talked with insurers and employers to ascertain their reactions. They also looked at the issue of "prediabetes" and the effect of that classification. At the end of their discussions, the committee concluded that applying the term prehypertensive would not have an impact on insurability issues. A question that drew more applause was the issue of how to tell patients with blood pressure of 120/80 mm Hg, who had previously considered themselves healthy, that they are now "prehypertensive." It was believed that patients will interpret this to mean that they now have hypertension. Dr. Chobanian agreed that the JNC 7 report has made physicians' lives "more complicated," admitting that the new concept will not be accepted overnight. It will involve a lot of education and it will take a few years to get the public to understand that prehypertension is something they should do something about, he predicted. He believes that this is an opportunity to affect the lifelong risk for hypertension, however. He further noted that JNC 7 does not recommend drugs, but healthier lifestyles that are healthier for many other reasons, and he also confirmed that for individuals who are in the prehypertension category, JNC 7 sets no goal as to how low their blood pressure should be reduced. 编辑 郑麓薇