适合于自身经济发展水平和健康保健系统，对JNC 7 中几乎没有提到的"全球心血管危险评估"作出自己的建议，并在此基础上给予医师一个相对灵活指导。这就是欧洲指南提出的主导思想。那么我们是否也需要一个基于中国的经济发展，适合中国临床医师使用，让中国患者能接受的治疗指南？

◆The Rationale for New Guidelines

Prior to the publication of the new ESH guidelines, both the ESH and the ESC had simply endorsed the guidelines formulated by the International Society of Hypertension (ISH) and the World Health Organization (WHO). However, the Europeans had come to believe that they needed to issue their own guidelines, according to Professor Mancia, because the WHO/ISH guidelines, last published in 1999,[6] were concerned with a global vision and dealt largely with issues concerning the developing world, where the health problems are different from those pertaining only to Europe. Thus, what Europeans may find unacceptable in terms of blood pressure thresholds, targets, diagnostic procedures, and drugs may be the only options in low-income countries, he explained. For instance, in low-income countries, it would not be possible to talk about diagnosing subclinical organ damage by echocardiography, and conversely, diuretics could be the best choice of treatment in these countries whereas more recently developed (and often more expensive) drugs may represent better therapeutic options in Europe.

Since most parts of Europe have well-developed health systems, European physicians felt they should have a new set guidelines, separate from those issued by WHO/ISH, that more nearly reflected the European realities. The WHO/ISH will continue to update their guidelines, but they have also called for the creation of more regional guidelines, and the new European guidelines have been formally endorsed by the ISH.

Importance of the Guidelines

An important aspect of the guidelines, Professor Mancia emphasized, is that they underline the relevance of calculating the so-called "global cardiovascular risk." This is a multifactorial risk assessment that incorporates the blood pressure values, associated risk factors, and risk of future organ damage, on which so many aspects of the decision-making process depend, including the timing, aggressiveness, and associated elements of treatment, as well as the target blood pressure values to be reached with therapy. This is emphasized in the new ESH guidelines, at variance from the JNC 7 guidelines, in which little attention was given to the calculation or quantification of the global cardiovascular risk, according to Professor Mancia.
Mancia also noted that a further important aspect of the ESH strategy is that there is no single value dividing normotension from hypertension. The threshold for initiation of blood pressure treatment is flexible, and should be seen as flexible, depending on the global cardiovascular risk

(As an important aside, Professor Mancia noted that if a patient's overall risk profile is not high, then it should not be said that the patient is "at low risk"; rather the correct terminology should be "low added risk" because it is an increase in relative risk compared with "no additional risk.")
The advantage of this strategy for categorizing risk is that it is very simple. The disadvantage, Professor Mancia acknowledged, is the possible compromise on accuracy, because it does not take into account, for example, the duration of the disease. Patients with diabetes and hypertension are automatically at high risk, but having diabetes for 20 years is different from having diabetes for 2 years. At the same time, however, it must be noted that epidemiology is an inexact science, Professor Mancia admitted.

编辑 郑麓薇