New guidelines suggest that people over age 60 can have a higher blood pressure than previously recommended before starting treatment to lower it.Toby Talbot/Associated PressNew guidelines suggest that people over age 60 can have a higher blood pressure than previously recommended before starting treatment to lower it.

3 Things to Know About the New Blood Pressure Guidelines http://nyti.ms/1jioz7j

2014 Evidence-Based Guideline for the Management of High Blood Pressure in AdultsReport From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)




最近新的JNC 8血壓值guideline出來了，把血壓治療的目標由140/90 mmHg上調至150/90 mmHg，讓我鬆了一口氣，因為要把洗腎患者的血壓控制在140/90 mmHg以下這個完美的目標，實在不容易，因為在某些患者這樣的血壓 ，洗腎日時實在無法無法順利脫水，常常會有血壓下降的危險。
First, the guidelines raise the systolic blood pressure (the top number of the blood pressure reading) threshold for drug treatment from 140 to 150 for people 60 and older.
Second, there is insufficient medical evidence to support a systolic blood pressure threshold for the drug treatment of people younger than 60.
The authors of the guidelines similarly also stated that we lack evidence for the right target for patients with kidney disease and diabetes. Given the lack of evidence, the authors settled on a recommendation of a goal of less than 140/90 for patients for people with kidney disease and also those with diabetes. This is a change for many people because many doctors have been seeking a systolic blood pressure goal of less than 130, but the authors noted that such a recommendation is not supported by any clinical trial.
和我們密切相關的是腎臟病，和糖尿病患者，之前目標是SBP < 130 mmhg，然而，JNC 8告訴我們，這SBP < 130是缺乏證據的，所以，JNC 8建議在腎臟或是糖尿病患者，目標是SBP <140 mmhg="" p="">
然而，DBP < 90 mmHg是必要的，甚至在30歲以上患者，也是建議 DBP <  90 mmHg（可見DBP控制的重要性）。
Third, the guidelines recognize that the modification of a risk factor – in this case hypertension, which is a risk factor for heart attacks and strokes and premature death – by drug therapy does not necessarily mean that you have reduced someone’s risk for these adverse health events.
對於一些輕微的高血壓患者，用藥物讓血壓再下降一些，也是看不到益處的，但是不可否認的，對於嚴重高血壓，還是要藥物治療。(Several studies sought to reduce risk by lowering blood pressure from mildly elevated to lower levels – and the surprising finding was that there was no benefit.)作者提出，降血壓藥物治療也是會有副作用的，若是用藥物來治療輕微的高血壓，那我們應該要注意治療的副作用是否會大於益處？
Additionally, there are other important aspects of these guidelines. 除了藥物治療外，別忘了健康飲食、體重控制和規律運動重要性。另外，在白人和黑人的藥物建議是不一樣的，若是黑人，不建議用ACEI或是ARB。對於beta-blocker，也是不建議用於治療高血壓。對於一般化的高血壓建議，是用thiazide-type diuretics and calcium channel blockers (CCB)來治療.
In summary, this is a large paradigm change.
..., particularly if they started drug treatment for mildly elevated blood pressure.

沒錯，這些輕微的高血壓患者，是否要開始治療高血壓，請和醫師們再討論。
Harlan Krumholz is a cardiologist and the Harold H. Hines Jr. Professor of Medicine, director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation and director of the Robert Wood Johnson Clinical Scholars Program at Yale University School of Medicine.