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引用：http://greenisland.csie.nctu.edu.tw/wp/2009/07/12/2050/
原文標題：No benefit in lowering BP below "standard" 140/90 mm Hg
原文網址：http://www.theheart.org/article/985113.do
====================================================
San Pedro de Montes de Oca, Costa Rica - A new review has found that lowering blood pressure below the 「standard」 target of 140/90 mm Hg is not beneficial in terms of reducing mortality or morbidity [1]. Dr
Jose Agustin Arguedas (Universidad de Costa Rica, San Pedro de Montes de Oca) and colleagues report their findings online July 8, 2009 in the Cochrane Database of Systematic Reviews.
研究者發現把血壓降到 140/90 mm Hg 的標準以下並沒有降低死亡率或是發病率[1]。
[1] Arguedas JA, Perez MI, Wright JM. Treatment blood pressure targets for hypertension. Cochrane Database Syst Rev 2009; 3:CD004349.
They explain that over the past five years, a trend toward lower targets has been recommended by hypertension experts who set treatment guidelines, 「based on the assumption that the use of drugs to bring the BP lower than 140/90 mm Hg will reduce heart attack and stroke.」But this approach 「is not proven,」 they point out.
研究者說在過去的五年，訂立治療準則的高血壓專家都傾向於降低高血壓的設定，「利用藥物讓血壓降到 140/90 mm Hg以下將能夠降低心臟病和中風發作的危險」，但是研究者指出「這種治療方法並沒有證明其有效性」。
Arguedas told heartwire that they reviewed seven trials with more than 22 000 subjects comparing lower or standard diastolic BP targets, but they were unable to identify any studies comparing different systolic
BP targets. 「We found there is no evidence that reaching a target of below 90 mm Hg diastolic BP will provide additional clinical benefit, but we can't say whether lowering systolic BP below 140 mm Hg will be beneficial or not; there are no data.」
研究者說並沒有證據顯示把舒張壓降低到 90 mm Hg 以下能提供更多的臨床上的好處，但降低收縮壓至 140 mm Hg 以下有沒有好處，也沒有證據能說明。
Dr Franz Messerli (St Luke Roosevelt Hospital, New York, NY), who was not involved with this review, told heartwire that there is no question that the 140/90-mm-Hg BP limit is 「absolutely arbitrary, and the benefits of antihypertensive medications are most obvious in patients with the highest BP. The closer we get to『normotension,』 the more difficult it becomes to show benefits of BP lowering.
訂出 140/90 mm Hg的血壓限制完全是任意的，使用抗高血壓藥物的好處在擁有最高血壓的病人身上最明顯。但是當我們越接近「正常」血壓，降血壓藥物能帶給我們的好處就越不容易顯現。
「The Lewington meta-analysis of one million patients has convincingly shown that people fare better—ie, have fewer strokes and heart attacks—when their 『usual' BP is 115/70 mm Hg compared with those with
a 『usual' BP of 130/80,」 Messerli adds. 「However there are no data and probably never will be that lowering BP from 130/80 mm Hg to 115/70 mm Hg confers any benefits,」 he says.
…Attempting to achieve lower BP targets has several consequences, the researchers note; 「the most obvious is the need for large doses and increased number of antihypertensive drugs. This has inconvenience and economic costs to patients. More drugs and higher doses will also increase adverse drug effects, which if serious could negate any potential benefit associated with lower BP.」 There is also the potential that lowering BP too much may cause adverse cardiovascular events, the so-called 「J-curve」 phenomenon, they observe.
研究者說，希望降低血壓有幾個後果：「最明顯的是降血壓藥物的使用劑量會越來越大，這當然對於病人的經濟造成負擔，越來越多種的藥物和越來越高的劑量也會增加藥物的副作用，而所產生的副作用可能嚴重到抵消因藥物降低血壓所帶來的種種好處。」研究者也觀察到，如果血壓降得太多可能會對心血管造成一些被稱為「J 曲線現象」的副作用。
---------------------
J 曲線現象指的是，當把血壓或膽固醇的濃度與死亡率畫成圖表時，會發現越接近曲線頂部，也就是血壓/膽固醇越高的人，死亡率也越高；但在另一端極低血壓/膽固醇的人也有較高的死亡率，所以看起來就像一個J 一樣。參考美國心臟協會的說明。不過美國心臟協會的說明中最後一段很有趣：
The notion that effectively lowering blood pressure or cholesterol levels may be harmful is unfounded and shouldn't influence clinical practice.
有效地降低血壓和膽固醇可能會造成危害的說法是沒有根據的，不應該影響到臨床上的治療。
---------------------
「This strategy did not prolong survival or reduce stroke, heart attack, heart failure, or kidney failure,」 they note. 「More trials are needed, but at present there is no evidence to support aiming for a blood-pressure target lower than 140/90 mm Hg in any hypertensive patient.」
The researchers say they were unable to fully assess the net health effect of lower targets due to lack of information regarding all total serious adverse events and withdrawals due to adverse effects in six of seven trials.
原文標題：No benefit in lowering BP below "standard" 140/90 mm Hg
原文網址：http://www.theheart.org/article/985113.do
====================================================
San Pedro de Montes de Oca, Costa Rica - A new review has found that lowering blood pressure below the 「standard」 target of 140/90 mm Hg is not beneficial in terms of reducing mortality or morbidity [1]. Dr
Jose Agustin Arguedas (Universidad de Costa Rica, San Pedro de Montes de Oca) and colleagues report their findings online July 8, 2009 in the Cochrane Database of Systematic Reviews.
研究者發現把血壓降到 140/90 mm Hg 的標準以下並沒有降低死亡率或是發病率[1]。
[1] Arguedas JA, Perez MI, Wright JM. Treatment blood pressure targets for hypertension. Cochrane Database Syst Rev 2009; 3:CD004349.
They explain that over the past five years, a trend toward lower targets has been recommended by hypertension experts who set treatment guidelines, 「based on the assumption that the use of drugs to bring the BP lower than 140/90 mm Hg will reduce heart attack and stroke.」But this approach 「is not proven,」 they point out.
研究者說在過去的五年，訂立治療準則的高血壓專家都傾向於降低高血壓的設定，「利用藥物讓血壓降到 140/90 mm Hg以下將能夠降低心臟病和中風發作的危險」，但是研究者指出「這種治療方法並沒有證明其有效性」。
Arguedas told heartwire that they reviewed seven trials with more than 22 000 subjects comparing lower or standard diastolic BP targets, but they were unable to identify any studies comparing different systolic
BP targets. 「We found there is no evidence that reaching a target of below 90 mm Hg diastolic BP will provide additional clinical benefit, but we can't say whether lowering systolic BP below 140 mm Hg will be beneficial or not; there are no data.」
研究者說並沒有證據顯示把舒張壓降低到 90 mm Hg 以下能提供更多的臨床上的好處，但降低收縮壓至 140 mm Hg 以下有沒有好處，也沒有證據能說明。
Dr Franz Messerli (St Luke Roosevelt Hospital, New York, NY), who was not involved with this review, told heartwire that there is no question that the 140/90-mm-Hg BP limit is 「absolutely arbitrary, and the benefits of antihypertensive medications are most obvious in patients with the highest BP. The closer we get to『normotension,』 the more difficult it becomes to show benefits of BP lowering.
訂出 140/90 mm Hg的血壓限制完全是任意的，使用抗高血壓藥物的好處在擁有最高血壓的病人身上最明顯。但是當我們越接近「正常」血壓，降血壓藥物能帶給我們的好處就越不容易顯現。
「The Lewington meta-analysis of one million patients has convincingly shown that people fare better—ie, have fewer strokes and heart attacks—when their 『usual' BP is 115/70 mm Hg compared with those with
a 『usual' BP of 130/80,」 Messerli adds. 「However there are no data and probably never will be that lowering BP from 130/80 mm Hg to 115/70 mm Hg confers any benefits,」 he says.
…Attempting to achieve lower BP targets has several consequences, the researchers note; 「the most obvious is the need for large doses and increased number of antihypertensive drugs. This has inconvenience and economic costs to patients. More drugs and higher doses will also increase adverse drug effects, which if serious could negate any potential benefit associated with lower BP.」 There is also the potential that lowering BP too much may cause adverse cardiovascular events, the so-called 「J-curve」 phenomenon, they observe.
研究者說，希望降低血壓有幾個後果：「最明顯的是降血壓藥物的使用劑量會越來越大，這當然對於病人的經濟造成負擔，越來越多種的藥物和越來越高的劑量也會增加藥物的副作用，而所產生的副作用可能嚴重到抵消因藥物降低血壓所帶來的種種好處。」研究者也觀察到，如果血壓降得太多可能會對心血管造成一些被稱為「J 曲線現象」的副作用。
---------------------
J 曲線現象指的是，當把血壓或膽固醇的濃度與死亡率畫成圖表時，會發現越接近曲線頂部，也就是血壓/膽固醇越高的人，死亡率也越高；但在另一端極低血壓/膽固醇的人也有較高的死亡率，所以看起來就像一個J 一樣。參考美國心臟協會的說明。不過美國心臟協會的說明中最後一段很有趣：
The notion that effectively lowering blood pressure or cholesterol levels may be harmful is unfounded and shouldn't influence clinical practice.
有效地降低血壓和膽固醇可能會造成危害的說法是沒有根據的，不應該影響到臨床上的治療。
---------------------
「This strategy did not prolong survival or reduce stroke, heart attack, heart failure, or kidney failure,」 they note. 「More trials are needed, but at present there is no evidence to support aiming for a blood-pressure target lower than 140/90 mm Hg in any hypertensive patient.」
The researchers say they were unable to fully assess the net health effect of lower targets due to lack of information regarding all total serious adverse events and withdrawals due to adverse effects in six of seven trials.
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