Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document

作者：Giuseppe Mancia, Stéphane Laurent, Enrico Agabiti‐Rosei, Ettore Ambrosioni, Michel Burnier, Mark J. Caulfield, Renata Cífková, Denis Clément, António Coca, Anna F. Dominiczak, Serap Erdine, Robert Fagard, Csaba Farsang, Guıdo Grassı, Hermann Haller, Antony Heagerty, Sverre E. Kjeldsen, Wolfgang Kiowski, Jean Mallion, Athanasios Manolis, Krzysztof Narkiewicz, Peter M. Nilsson, Michael Hecht Olsen, K. H. Rahn, Josep Redón, José L. Rodicio, Luís M. Ruilope, Roland E. Schmieder, Harry A.J. Struijker-Boudier, Pieter A. van Zwieten, Margus Viigimaa, Alberto Zanchetti · 发表于：Blood Pressure · 年份：2009 · DOI：10.3109/08037050903450468 · 被引用次数：898 · 研究领域：Blood Pressure and Hypertension Studies、Sodium Intake and Health、Cardiovascular Health and Disease Prevention

Many important decisions on hypertension management must currently be taken without the support of evidence \nfrom large randomized controlled trials. The following issues appear in urgent need to be approached by simply \ndesigned trials. \n(1) Should antihypertensive drugs be prescribed to all patients with grade 1 hypertension, even when total \ncardiovascular risk is relatively low or moderate? Because of the very low rate of cardiovascular events \nexpected in these patients, a placebo-controlled trial using intermediate endpoints such as signs of organ \ndamage of recognized prognostic importance would be feasible, ethical, and clinically relevant. \n(2) Should antihypertensive drugs be prescribed to the elderly with grade 1 hypertension, and should antihypertensive \ntreatment achieve a goal of below 140/90mmHg also in the elderly? These trials could make use \nof hard cardiovascular outcomes and could be placebo-controlled. \n(3) Should antihypertensive drug treatment be started in diabetic patients or in patients with previous cerebrovascular \nor cardiovascular disease when BP is still in the high normal level, and should BP goal be below 130/ \n80mmHg in these patients? These issues can be approached by placebo-controlled trials because no trial \nevidence is still available on the benefit of lowering high normal BP or of achieving BP goals below 130/ \n80mmHg. \n(4) What are the lowest safe BP values to achieve by treatment in different clinical conditions? This i...