在出现健康并发症之前，人们很容易忽视高血压或高血压。不幸的是，许多人直到患上心脏病、肾损伤或中风后才意识到高血压的影响。
It's easy to ignore high blood pressure, or hypertension, until health complications strike. Unfortunately, many people don't realize the impact of high blood pressure until they develop heart disease, have kidney damage or suffer a stroke.
高血压的官方标准最近发生了变化，阈值降低到130/80 mmHg。根据美国心脏协会的数据，现在有超过 1 亿美国人患有高血压。随着指南和治疗参数的变化，您可能不知道自己是否患有高血压或如何保护自己的健康。
The official standard for high blood pressure recently changed, with the threshold lowered to 130/80 mmHg. More than 100 million Americans now have high blood pressure, according to the American Heart Association. As guidelines and treatment parameters shift, you may not know whether you have high blood pressure or how to safeguard your health.
比以往任何时候都更鼓励患者跟踪自己的进展并采取积极措施来降低风险。好消息是，如果您是众多被诊断出患有高血压的人之一，那么您可以采取很多措施来控制高血压、预防并发症并将血压降至正常范围。
More than ever, patients are encouraged to track their own progress and take proactive measures to reduce their risks. The good news is that if you're among the many people diagnosed with hypertension, there's plenty you can do to manage it, prevent complications and bring your blood pressure down to a normal range.
体征和症状
Signs and Symptoms
阿拉巴马大学伯明翰分校生物统计学系教授 Suzanne Judd 说，公共卫生面临的挑战是大多数人感觉不到慢性高血压。
The public health challenge is that most people can't feel chronic high blood pressure, says Suzanne Judd, a professor in the department of biostatistics with the University of Alabama at Birmingham.
高血压被称为“沉默的杀手”是有充分理由的。除非您正在经历称为高血压危象的医疗紧急情况，否则您不太可能出现作为高血压警告信号的症状。对于大多数人来说，未经治疗的慢性高血压会随着时间的推移缓慢而稳定地造成损害。
High blood pressure is called the "silent killer" for good reason. Unless you're experiencing the medical emergency known as a hypertensive crisis, you're unlikely to have symptoms that serve as high blood pressure warning signs. For most people, untreated chronic high blood pressure will slowly but steadily do its damage over time.
根据 AHA 指南，高血压危机是指血压迅速飙升至 180/120 的读数。严重的头痛、呼吸急促、流鼻血和急性焦虑可能伴随症状。高血压急症包括血压读数升高以及胸痛或背痛、虚弱、麻木或说话困难等症状。
Hypertensive crisis is when blood pressure rapidly spikes to readings of 180/120, according to AHA guidelines. Severe headache, shortness of breath, nosebleeds and acute anxiety may be accompanying symptoms. Hypertensive emergency encompasses the elevated blood pressure reading along with symptoms such as chest or back pain, weakness, numbness or difficulty speaking.
为什么必须控制高血压
Why You Must Control High Blood Pressure
正常的心率约为每分钟 60 到 100 次。每一次心跳都会将血液泵入动脉、静脉和毛细血管——您的血管网络。源源不断的血流不断地推着动脉壁。这种永无止境的力量就是你的血压。
A normal heart rate runs at about 60 to 100 beats per minute. Every heartbeat pumps blood through the arteries, veins and capillaries – your network of blood vessels. The ceaseless blood flow continuously pushes against the arterial walls. This never-ending force is your blood pressure.
当称为小动脉的微小动脉（调节身体的血流）变得更紧时，就会引起高血压。这种收缩迫使您的心脏更用力地泵血，从而导致血管内产生压力。
High blood pressure is caused when tiny arteries called arterioles – which regulate the body's blood flow – become tighter. This constriction forces your heart to pump harder, causing pressure to build within the blood vessels.
高血压的后果可能是毁灭性的，降低血压可以挽救生命。达拉斯德克萨斯大学西南医学中心高血压奖学金项目主任 Wanpen Vongpatanasin 博士说，在改善心血管健康和减少脑部并发症（如中风）方面，风险降低尤其明显。相比之下，不受控制的高血压会缩短您的寿命。 “最终，当您患有心力衰竭和中风时，会增加死亡率，”她说。
Hypertension consequences can be devastating and lowering your blood pressure can be lifesaving. The risk reduction is particularly strong in terms of improving cardiovascular health and reducing brain complications like stroke, says Dr. Wanpen Vongpatanasin, director of the Hypertension Fellowship Program at University of Texas Southwestern Medical Center in Dallas. By contrast, uncontrolled high blood pressure can shorten your life. "Ultimately when you have heart failure and stroke, you increase mortality," she says.
肾脏疾病是另一个主要并发症。根据美国国家糖尿病、消化和肾脏疾病研究所的数据，高血压会损害肾脏血管，是美国肾功能衰竭的第二大原因。
Kidney disease is another major complication. High blood pressure, which can damage blood vessels in the kidneys, is the second-leading cause of kidney failure in the U.S., according to the National Institute of Diabetes and Digestive and Kidney Diseases.
持续的、不受控制的高血压也可能导致视力丧失、性功能障碍和外周动脉疾病。
Vision loss, sexual dysfunction and peripheral artery disease may also result from ongoing, uncontrolled hypertension.
血压和大脑
Blood Pressure and the Brain
SPRINT 研究系列研究了强化血压控制——以低于 120 的收缩压（上限数字）为目标——对特定医疗条件的影响。研究人员发现，与收缩压低于 140 的不太严格的目标相比，当高危患者严格控制血压时，心脏病发作、不稳定型心绞痛、中风和心力衰竭会减少。
The SPRINT study series looked at the effects of intensive blood pressure control – with a systolic pressure (the upper number) of less than 120 as the target – on specific medical conditions. Heart attack, unstable angina, stroke and heart failure are reduced when high-risk patients have tightly controlled blood pressure, compared to a less-stringent goal of a systolic blood pressure of less than 140, researchers found.
新出现的证据表明，严格控制血压可能有助于保护大脑功能。 “在最近的试验中，我们开始看到对认知功能的潜在影响模式，”Vongpatanasin 说。
Tight blood pressure control may help preserve brain function, emerging evidence suggests. "In more recent trials, we begin to see a pattern of potential effects on cognitive function," Vongpatanasin says.
SPRINT MIND 研究的结果于 2019 年 1 月 18 日发表在《美国医学会杂志》上。与标准血压控制相比，严格的血压控制将可能患痴呆症的风险降低了 17%。这种差异没有统计学意义。然而，严格的血压控制与轻度认知障碍的发生率降低 19% 相关——这是一个重要的发现。
Results of the SPRINT MIND study were reported Jan. 18, 2019, in the Journal of the American Medical Association. Tight blood pressure control reduced the risk of probable dementia by 17% compared to standard blood pressure control. This difference was not statistically significant. However, tight blood pressure control was tied to a 19% lower rate of mild cognitive impairment – a significant finding.
高血压危险因素
Hypertension Risk Factors
高血压的一些危险因素是您无法控制的。年龄较大、高血压家族史和非裔美国人会增加患高血压的可能性。
Some risk factors for high blood pressure are beyond your control. Older age, a family history of hypertension and being African American increase your likelihood of developing hypertension.
糖尿病、肾脏疾病和睡眠呼吸暂停等慢性疾病会使您面临更高的高血压风险。妊娠高血压和先兆子痫是妊娠期间可能出现的高血压疾病。
Chronic medical conditions such as diabetes, kidney disease and sleep apnea put you at higher hypertension risk. Gestational hypertension and preeclampsia are high blood pressure conditions that can arise during pregnancy.
超重或肥胖会增加您的风险，久坐的生活方式也是如此。使用烟草、摄入过多盐（或钠）和大量饮酒也会增加患病风险。
Being overweight or obese increases your risk, as does having a sedentary lifestyle. Tobacco use, consuming too much salt (or sodium) and heavy drinking also increase your risk.
尽管老年人更容易患高血压，但它越来越早地出现在生命的早期。 “就在最近，我们也开始在 20 岁以下的年轻人群中看到这种情况，”UAB 公共卫生学院李斯特希尔健康政策中心主任贾德说。 “这可能是因为越来越多的美国人变得肥胖。这绝对是一个问题。”
Although older adults are more likely to have high blood pressure, it's increasingly showing up earlier in life. "Quite recently, we started seeing it in very young people under the age of 20, as well," says Judd, who is the director of the Lister Hill Center for Health Policy at the UAB School of Public Health. "That's probably due to the way more and more Americans are becoming obese. It's definitely a concern."
如何控制高血压
How You Can Control High Blood Pressure
血压药物
Blood Pressure Medications
据美国食品和药物管理局称，有九种药物类别用于治疗高血压。每种药物类别都有不同的降血压作用：
Nine drug classes are used to treat high blood pressure, according to the Food and Drug Administration. Each medication class has different blood pressure lowering effects:
血管紧张素转换酶抑制剂。 ACE 抑制剂通过抵消一种使血管变窄的激素来帮助放松血管。依那普利 (Vasotec) 和赖诺普利 (Prinivil 和 Zestril) 是常用的 ACE 抑制剂。
Angiotensin converting enzyme inhibitors. ACE inhibitors help relax the blood vessels by counteracting a hormone that otherwise narrows them. Enalapril (Vasotec) and lisinopril (Prinivil and Zestril) are frequently prescribed ACE inhibitors.
β 阻滞剂：这些可以减少压力荷尔蒙对心脏的影响。美托洛尔（Lopressor 和 Toprol-XL）和纳多洛尔（Corgard）是常用的 β 受体阻滞剂。
Beta blockers. These reduce the effect of stress hormones on the heart. Metoprolol (Lopressor and Toprol-XL) and nadolol (Corgard) are commonly used beta blockers.
利尿剂：也称为“水丸”，利尿剂作用于肾脏，帮助排出体内多余的水和钠，从而降低血管壁上的液体压力。治疗高血压的噻嗪类利尿剂包括氢氯噻嗪（Microzide）和氯噻嗪（Diuril）。
Diuretics. Also known as "water pills," diuretics work on the kidneys to help flush excess water and sodium from the body and thereby reduce fluid pressure on blood vessel walls. Thiazide-type diuretics to treat high blood pressure include hydrochlorothiazide (Microzide) and chlorothiazide (Diuril).
血管紧张素 II 受体阻滞剂：这些也有助于放松血管。氯沙坦 (Cozaar) 和缬沙坦 (Diovan) 是两种类型的 ARB。
Angiotensin II receptor blockers. These also help relax the blood vessels. Losartan (Cozaar) and valsartan (Diovan) are two types of ARBs.
钙通道阻滞剂：顾名思义，这些药物通过阻止钙进入细胞来放松心肌和血管。氨氯地平（Norvasc）和地尔硫卓（Cardizem 和 Tiazac）就是例子。
Calcium channel blockers. As the name implies, these drugs relax the heart muscle and blood vessels by blocking calcium from entering cells. Amlodipine (Norvasc) and diltiazem (Cardizem and Tiazac) are examples.
中枢代理：这些药物通过对大脑和神经系统的影响来降低血压。可乐定（Catapres 和 Kapvay）和甲基多巴属于这一类。
Centrally acting agents. These medications reduce blood pressure through their effects on the brain and nervous system. Clonidine (Catapres and Kapvay) and methyldopa belong to this class.
外周作用剂：通过阻止大脑、肾上腺和某些身体组织释放压力激素，利血平 (Serpalan) 等外周作用抗肾上腺素药物有助于降低血压。
Peripherally acting agents. By preventing the brain, adrenal glands and certain bodily tissues from releasing stress hormones, peripherally acting antiadrenergic medicines like reserpine (Serpalan) help reduce blood pressure.
血管扩张剂：诸如肼苯哒嗪和米诺地尔之类的血管扩张剂通过直接靶向血管壁起作用。
Vasodilators. Vasodilators such as hydralazine and minoxidil work by directly targeting blood vessel walls.
肾素抑制剂：肾素抑制剂药物阿利吉仑 (Tekturna) 还有助于血管放松和扩张，以改善血液流动。
Renin inhibitors. The renin inhibitor drug aliskiren (Tekturna) also helps blood vessels relax and dilate to improve blood flow.
是否以及何时开始抗高血压治疗需要与您的医疗保健提供者进行讨论。个别高血压药物具有独特的益处和副作用。医生可能会联合开两种或多种降压药，以最大限度地发挥作用。
Whether and when to start antihypertensive treatment is a discussion to have with your health care provider. Individual hypertension medications have unique benefits and side effects. Doctors may prescribe two or more blood pressure lowering drugs in combination to maximize the effect.
寻找正确的药物治疗方案也是一个双向的过程。 “人们应该与他们的医生建立良好的合作关系，这样才能轻松地说‘这种药物让我感觉不舒服'，”贾德说，他强调了控制和倡导自己健康的重要性。
Finding the right drug regimen is also a two-way process. "People should have a good, collaborative relationship with their physician to be comfortable saying, 'This medication does not make me feel well,'" says Judd, who emphasizes the importance of being in control of and an advocate for your own health.
生活方式
Lifestyle
高血压是一种健康状况，生活方式的改变确实会对其产生影响。减少吸烟和酗酒等风险因素，保持健康的体重和保持身体活动有助于预防或降低高血压。
Hypertension is a health condition for which lifestyle changes really make a difference. Cutting back on risk factors such as smoking and heavy drinking, maintaining a healthy weight and staying physically active can help prevent or reduce high blood pressure.
根据政府的建议，成年人每周应至少进行 150 分钟的体育锻炼。运动或活动的类型和强度可能因您的年龄、一般健康状况或慢性疾病而异。
Adults should do at least 150 minutes of physical activity a week, according to government recommendations. The type and intensity of exercise or activity may vary depending on your age, general health or chronic medical conditions.
家庭监控的重要性
Home Monitoring Importance
2017 年，美国心脏病学会和美国心脏协会联合发布了预防、检测、评估和管理高血压的新指南。在家中自我监测血压是指导重点。
In 2017, the American College of Cardiology and American Heart Association jointly released new guidelines for preventing, detecting, evaluating and managing high blood pressure. Self-monitoring blood pressure at home was a guideline focus.
定期在家监测显示血压波动和趋势，而定期诊所预约或检查根本无法捕捉到。贾德说，保持血压数值“至关重要”。与您的医生分享持续的血压趋势将更好地告知治疗目标。
Regular at-home monitoring reveals blood pressure fluctuations and trends that periodic clinic appointments or checkups simply can't capture. Staying on top of your blood pressure number is "critical," Judd says. Sharing ongoing blood pressure trends with your doctor will better inform treatment goals.
最近由 Vongpatanasin 领导的一项研究于 2018 年 12 月发表在 Hypertension 杂志上，支持家庭监测的价值。
A recent study led by Vongpatanasin, published December 2018 in the journal Hypertension, supported the value of home monitoring.
追踪您的血压
Tracking Your Blood Pressure
为了获得更准确、一致的结果，贾德提供了以下自我监控建议：
For more accurate, consistent results, Judd offers these self-monitoring suggestions:
测量血压时坐着，而不是站着或躺着。
Sit while measuring blood pressure, rather than standing or lying down.
在相对平静的情况下检查您的血压——而不是在匆匆忙忙或办完事后立即检查。
Check your blood pressure while relatively calm – not right after rushing around or doing errands.
每天在同一时间测量血压，比如早上起床时。
Measure blood pressure at the same time each day, like in the morning when you wake up.
注意饮食因素，如酒精或咸味食物，它们可以暂时略微升高血压。
Be aware of dietary factors like alcohol or salty foods that can slightly boost blood pressure temporarily.
不要对读数的微小变化感到惊慌，例如从 130 上升到 140。
Don't be alarmed by small changes in readings, such as going from 130 up to 140.
认真对待 30 mmHg 或更高的血压波动，并让您的医生知道。
Take blood pressure swings of 30 mmHg or more seriously, and let your doctor know.
贾德建议，购买易于使用和阅读的血压计。具有大量数字和单个按钮的监视器可以简化血压跟踪。美国心脏协会提供在线血压跟踪工具。
Buy a blood pressure monitor that's easy to use and read, Judd advises. Monitors with big numbers and a single push-button can simplify blood pressure tracking. The American Heart Association offers an online blood pressure tracking tool.
盐和你的饮食
Salt and Your Diet
一般来说，保持健康的体重有助于控制血压。像 DASH 这样的饮食计划代表阻止高血压的饮食方法，提供特定的食物选择。 Vongpatanasin 说，素食或地中海饮食也可能有帮助。
In general, maintaining a healthy weight helps keep blood pressure under control. Eating plans like DASH, which stands for dietary approaches to stop hypertension, offer specific food choices. A vegetarian or Mediterranean diet might also be helpful, Vongpatanasin says.
她指出，盐敏感性影响了大约 30% 的人。具有遗传联系的盐敏感性使身体更难摆脱多余的钠。食盐只占大多数人摄入的钠的一小部分。任何患有高血压的人，尤其是对盐分敏感的人，都应该仔细阅读食品标签并检查钠含量。
Salt sensitivity affects about 30% of people, she points out. Salt sensitivity, which has a genetic connection, makes it harder for the body to get rid of excess sodium. Table salt only accounts for a small proportion of the sodium most people consume. Anyone with high blood pressure, and particularly those with salt sensitivity, should carefully read food labels and check sodium levels.
替代方法
Alternative Approaches
研究人员继续研究降低血压的替代方法。根据国家补充和综合健康中心的数据，在一些研究中，冥想和放松技巧在降低血压方面显示出适度的好处。
Researchers continue to examine alternative approaches to reducing blood pressure. In some studies, meditation and relaxation techniques have shown modest benefits in reducing blood pressure, according to the National Center for Complementary and Integrative Health.
