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◆Comprehensive Risk Assessment
Preferred
对危险因素进行全面评估，根据其总体心血管危险水平，才能对病人做出合理的处理；为求指南的简明扼要，不要求对病人作全面的血管危险评估，只在测量动脉压的基础上，决定是否或何时给予病人何种治疗，作为临床医生，简单是否就是最好？
Dr. Cohn continued his critique by stating his preference for a more
comprehensive assessment of vascular health, including other measurements
-- such as arterial elasticity, funduscopic examination, and microalbuminuria
-- before a patient is committed to lifestyle and drug interventions
that will last for life. Dr. Chobanian confirmed that microalbuminuria
is part of the JNC 7 recommendations, but emphasized that the committee
had aimed at making JNC 7 a "simple and straightforward"
guide for clinicians, not for hypertension specialists.
Professor Michael O'Rourke, MD, DSc (St Vincent's Hospital, Sydney,
Australia), noted that JNC 7 has moved away from JNC 6[4] and from
the World Health Organization (WHO)/International Society of Hypertension
(ISH)[5] guidelines to measures of arterial pressure rather than measures
of risk. He suggested that, given what is known about the inaccuracy
of the sphygmomanometric measurements in individual patients and the
fact that the root cause of isolated systolic hypertension can be
attributed to increasing pressure with age due to the effects of arterial
stiffness, consideration might be given to involving other aspects
of cardiovascular risk to supplement the cuff-sphygmomanometric measurements
in making assessments of when to treat patients. Dr. Chobanian replied
that measurements of cardiovascular risk were related to the other
major risk factors, such as cholesterol, diabetes, and smoking, and
the use of surrogate markers of risk was not included in the recommendations.
Several questioners commented on the absence of left ventricular hypertrophy
(LVH) as a compelling indication in JNC 7. Dr. Chobanian confirmed
that the issue of whether LVH should be a "compelling indication"
was discussed. The committee did not want to downgrade the importance
of LVH, and it will be present in the longer report as an important
factor, but it was decided that the data were not strong enough to
make it a compelling indication.
编辑 郑麓薇
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