◆No European "Prehypertensives"

一个简单的名词会给健康人扣上病人的帽子，一个简单的指南会让医生作出简单的判断，因素考虑与不考虑，危险评估与不评估，结论是截然不同的。

Professor Mancia disapproves of the term "prehypertensive," as used in JNC 7. "Words are stones," Professor Mancia warned, quoting Italian writer Carlo Levi (Le Parole Sono Pietre, 1955). Would we, for example, call a healthy subject "prediseased"? he asked. It is difficult to tell a patient, "You are prehypertensive, but don't do anything about it. Of course the patient is going to think that something is wrong and that he should see the doctor more frequently. He is going to go around asking for medical exams more frequently and he may want to have drugs anyway."

However, it is not only the word "prehypertensive" Professor Mancia objects to. According to JNC 7, the category of prehypertensive pools all subjects with SBP 120-139 mm Hg and DBP 80-89 mm Hg together. But to date, there is evidence of therapeutic benefit in this so-called high normal range only if the patient has a high or a very high additional risk. If a patient has a blood pressure of 122/82 mm Hg, for example, there is no evidence that the patient should get any form of pharmacologic treatment. However, if there is evidence that a patient with blood pressure 120/80 mm Hg is at high risk (eg, has diabetes and family history of hypertension), then this patient should in fact be assigned to drug treatment.

编辑 郑麓薇