·高被引论文摘要·

·高被引论文摘要·

被引频次：213

中国心血管病报告2013概要

陈伟伟，高润霖，刘力生，等

随着社会经济的发展，居民生活方式的变化，人口老龄化进程的加快等，心血管病危险因素水平持续增加，心血管病负担日渐加重，已成为重大的公共卫生问题。中国城乡居民心血管病患病率呈上升趋势，死亡率居高不下，全国每年约有 350 万人死于心血管病。心血管病是中国居民的首位死亡原因。加强心血管病防治刻不容缓。

心血管病；危险因素；患病率；死亡率

来源出版物：中国循环杂志, 2014, 29(7): 487-491

被引频次：241

我国14省市中老年人肥胖超重流行现状及其与高血压患病率的关系

陈捷，赵秀丽，武峰，等

摘要：目的：了解我国目前中老年人群肥胖超重的流行特征及其与常见慢性病的关系，为肥胖的社区防治提供科学依据。方法：利用我国14省市房颤流行病学调查资料，选择14个自然人群进行整群抽样调查，根据中国肥胖问题工作组推荐的中国成人超重肥胖诊断标准，对肥胖、超重患病情况进行统计分析。结果：14省市超重总患病率为38.93%，标准化率为37.17%；肥胖总患病率为13.94%，标准化率为12.63%。女性肥胖患病率显著高于男性，而男性超重患病率显著高于女性（均 P＜0.001）；超重肥胖的患病率随年龄增加呈现一定规律性；高血压患病率随人群体重指数（BMI）增加而显著增加。结论：我国超重和肥胖患病形势严峻，加强人群防治刻不容缓，控制体重对高血压等慢性病的防治具有重要意义。关键词：肥胖症；流行病学；高血压

来源出版物：中华医学杂志, 2005, 85(40): 2830-2834

被引频次：113

慢性病及亚健康状态对我国人民健康的影响及其防治原则

王陇德

摘要：当前慢性病及亚健康状态已影响到我国大部分群众的身体健康。如何改变这种状况，以努力实现十六大提出的全民族“健康素质明显提高”的目标，作者尝试提出一些观点，希望有助于全民保健工作的开展。作者主要从慢性病和亚健康状态对人类身体健康的危害以及如何保持人类身体健康等方面进行一些探讨。

来源出版物：中华医学杂志, 2003, 83(12): 1031-1034

被引频次：100

慢性病患者自我管理研究进展

张丽丽，董建群

摘要：病人主动参与慢性病管理的最终目的是提高病人的自我效能（self-efficacy）并开展有效的自我管理。慢性病自我管理的实质为通过“医患合作，患者互助，自我管理”来提高患者对疾病的认识水平，改善患者心理状态，改变患者不良健康行为，促进患者功能恢复，减少医疗费用支出。该文从心理学、生态学、伦理学、卫生经济学等领域对患者自我管理在不同角度、不同层次的研究进行探索，深入了解患者自我管理的科学性和有效性，同时就目前研究中存在的问题进行探讨。

关键词：慢性病；自我管理；社区；健康教育；效果评价来源出版物：中国慢性病预防与控制, 2010, 18(2):

207-211

被引频次：94

北京市2005年18岁及以上居民主要慢性病的流行特征和防治水平调查

张普洪，焦淑芳，周滢，等

摘要：目的：了解北京市主要慢性病的流行特征和防治水平。方法：于2005年9—10月份采用多阶段等比例分层整群抽样的方法调查北京市18岁以上16658名常住居民，调查方法包括问卷调查、体格测量和实验室检查。结果：患病率、知晓率、服药率和控制率，高血压分别为29.1%、49.3%、42.3%和10.6%，糖尿病分别为8.8%、56.7%、50.0%和15.0%，血脂异常分别为33.2%、31.1%、13.0%和4.3%；代谢综合征患病率为22.9%；急性心肌梗死和脑 卒 中的患 病 率分别为8.1‰和 18.4‰。除 糖 尿 病外，高血压、血脂异常、代谢综合征、急性心肌梗死和脑卒中的患病率都是郊区县人群高于城区。18～50岁人群上述慢性病的患病率男性显著高于女性，50岁后女性的患病水平逐渐赶上甚至超过男性。结论：北京市18岁以上常住居民中主要慢性病患病率高于既往调查资料，郊区人群患病水平已超过市区人群。应根据新的流行特点，调整和加强北京市慢性病防治的工作重点。

关键词：高血压；糖尿病；血脂异常；急性心肌梗死；脑卒中

来源出版物：中华流行病学杂志, 2007, (7): 625-630

被引频次：79

慢性病的主要危险因素流行水平及其预防策略的发展

孙晓东，吕筠，李立明

摘要：慢性病的流行已经引起全世界的广泛重视，WHO明确提出慢性病的3个主要危险因素：吸烟、缺乏体力活动和不健康饮食，并针对这些危险因素提出了全球性干预策略。我国在慢性病的防治方面也做了很多努力，但依然存在很多问题，如慢性病防治的政策支持环境尚未形成，慢性病防治工作缺乏法律保障等。根据国际性的慢性病防治策略和经验在中国开展健康促进策略，建立支持性的政策环境,开展综合性社区干预项目应该成为我国进一步开展慢性病防治工作的重点。

关键词：慢性病；危险因素；流行病学研究；疾病控制策略

来源出版物：中国慢性病预防与控制, 2008, 16(5): 538-540

被引频次：78

慢性病现状流行趋势国际比较及应对策略

李鹏，杨文秀

摘要：目的：了解目前世界慢性病的现状及其在可预测的未来的发展趋势，为决策者提供可行的慢性病防治政策建议。方法：根据世界银行给出的国家分类，从高收入国家、中高收入国家、中低收入国家、低收入国家中各随机抽取2个国家进行数据统计，还将所有地区和各收入层次国家总计进行了数据统计与分析。对国家间的慢性病主要疾病谱作横向比较。结果：全球范围内慢性病死亡人数占所有死亡人数的60%以上；慢性病死亡主要发生在低收入和中低收入国家，占慢性病死亡人数的70%以上；其中心血管系统疾病、癌症、慢性呼吸道疾病、糖尿病、孕期和围产期疾病及营养不良等疾病是导致死亡的5类主要慢性病。结论：慢性病对发展中国家的威胁与日俱增，发展中国家也需要加大对慢性病的防治力度。采取相关行动去减慢和遏制慢性病的上升趋势已成为全球公共卫生的当务之急。

关键词：慢性病；流行病学；国际性；卫生政策

来源出版物：天津医药, 2009, 47(4): 254-257

被引频次：60

北京市成年人主要慢性病流行特征分析

董忠，李刚，谢瑾，等

摘要：目的：分析北京市成年人常见慢性病的流行特征。方法：自行设计的调查问卷。于2008年10—11月，采用多阶段分层随机整群抽样方法对北京市18～79岁的22206名常住居民进行问卷调查、体格测量和实验室检查。结果：调查人群高血压、糖尿病、超重、肥胖、中心性肥胖 和 血 脂 异常的患病率分别为 30.3%、6.1%、36.2%、19.1%、51.5%和34.2%；其中男性分别为38.8%、8.2%、42.5%、22.5%、62.8%和42.9%，女性分别为27.9%、5.7%、34.7%、18.4%、47.9%和30.4%，男性各慢性病患病率均高于女性；郊区高血压和肥胖的患病率分别为34.8%和23.0%，已高于城区的31.6%和18.7%；＜50岁男性各种慢性病的患病率均高于女性，50～60岁糖尿病、肥胖、中心性肥胖和血脂异常的患病率则女性高于男性；男性的发病高峰在青壮年期，女性在绝经期。结论：肥胖和血脂异常已成为北京市成年人重要健康问题；郊区的慢性病患病水平已接近或超过城区。

关键词：高血压；糖尿病；肥胖；血脂异常；流行特征

来源出版物：中国公共卫生, 2004, 13(1): 357-358

被引频次：59

北京市2005年成年人慢性病相关生活方式和行为习惯研究

张普洪，焦淑芳，周滢，等

摘要：目的：探索北京市成年人中慢性病相关生活方式和行为习惯的分布特征。方法于 2005 年 9—11 月份采用多阶段等比例分层整群抽样的方法调查北京市18岁以上16658 名常住居民，凋查内容包括问卷调查、体格测量和实验室检查。结果北京市成年人有 33.2%超重，16.4%肥胖，腹型肥胖率为 45.6%。现在吸烟率为 26.2%，经常吸烟率为 21.4%，男女性现在吸烟率分别为 57.7%和4.6%。男性中 64.3%每月至少饮一次酒，16.1%几乎每

天饮酒，16.5%为过量饮酒，18.5%为单次大量饮酒。北京市成年人 46.0%缺乏体育锻炼（每周锻炼时间不超过2 h）。膳食中最突出的问题是钠盐和食用油摄入过多、豆奶制品摄入不足、不吃早餐、常吃咸菜腌菜和油炸食品、经常吃零食和蔬菜水果摄入不足等问题。绝大多数慢性病危险因素的流行水平都是郊县高于城区，青壮年高于其他年龄段。结论：北京市成年人中慢性病相关危险因素高度流行，郊县和青壮年是今后干预的重点。

关键词：慢性病；危险因素；肥胖；吸烟；体力活动

来源出版物：中华流行病学杂志, 2007, (12): 1162-1166

被引频次：56

天津社区居民慢性病患病现状及影响因素分析

王媛，于维莉，芦文丽，等

摘要：目的：了解天津市社区居民慢性病患病现状及其相关影响因素，为社区居民慢性病预防与控制提供科学依据。方法：采用分层随机抽样方法对在天津市抽取的2335名≥18岁社区居民进行问卷调查。结果：天津市社区居民慢性病患病率为33.96%，其中男性和女性居民的患病 率 分别为 33.89%和34.03%， 差 异无统 计 学意义（P＞0.05）；慢性病患病率随年龄的增长呈上升趋势（χ2=535.946，P=0.000）；居于慢性病患病前10位的疾病依次为高血压、糖尿病、冠心病、脑梗塞、颈椎病、腰间盘突出、骨关节炎、脑血栓、脑出血和胆石症，患病率依次为21.60%、7.64%、5.76%、67%、87%、72%、64%、60%、0.44%和0.40%；多因素非条件 Logistic 回归分析结果表明，年龄≥30岁、吸烟、超重、肥胖和有慢性病家族史是天津市社区居民慢性病患病的危险因素。结论：天津市社区居民慢性病患病率随年龄增长呈上升趋势；吸烟、超重、肥胖和有慢性病家族史的居民是慢性病防治的重点人群。

关键词：慢性病；高血压；吸烟；体重指数

来源出版物：中国公共卫生, 2012, 28(3): 296-298

被引频次：9620

来源出版物：Hypertension, 2003, 42(6): 1206-1252

被引频次：2875

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary

Rabe, Klaus F.; Hurd, Suzanne; Anzueto, Antonio; et al.

Abstract: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

Keywords: COPD; guidelines; human; chronic disease

来源出版物：American Journal of Respiratory and Critical Care Medicine, 2007, 176(6): 532-555

被引频次：2632

The hormone resistin links obesity to diabetes

Steppan, CM; Bailey, ST; Bhat, S; et al.

Abstract: Diabetes mellitus is a chronic disease that leads to complications including heart disease, stroke, kidney failure, blindness and nerve damage. Type 2 diabetes,characterized by target-tissue resistance to insulin, is epidemic in industrialized societies and is strongly associated with obesity; however, the mechanism by which increased adiposity causes insulin resistance is unclear. Here we show that adipocytes secrete a unique signalling molecule, which we have named resistin (for resistance to insulin). Circulating resistin levels are decreased by the anti-diabetic drug rosiglitazone, and increased in diet-induced and genetic forms of obesity. Administration of anti-resistin antibody improves blood sugar and insulin action in mice with diet-induced obesity. Moreover, treatment of normal mice with recombinant resistin impairs glucose tolerance and insulin action. Insulin-stimulated glucose uptake by adipocytes is enhanced by neutralization of resistin and is reduced by resistin treatment. Resistin is thus a hormone that potentially links obesity to diabetes.

来源出版物：Nature, 2001, 409(6818): 307-312

被引频次：2364

Prevalence of chronic kidney disease in the United States 12.0%-14.1%) in 1999-2004 with a prevalence ratio of 1.3 (95% CI, 1.2-1.4). The prevalence estimates of CKD stages in 1988-1994 and 1999-2004, respectively, were 1.7% (95% CI, 1.3%-2.2%) and 1.8% (95% CI, 1.4%-2.3%) for stage 1; 2.7% (95% CI, 2.2%3.2%) and 3.2% (95% CI, 2.6%-3.9%) for stage 2; 5.4% (95% CI, 4.9%-6.0%) and 7.7% (95% CI, 7.0%-8.4%) for stage 3; and 0.21% (95% CI, 0.15%-0.27%) and 0.35% (0.25%-0.45%) for stage 4. A higher prevalence of diagnosed diabetes and hypertension and higher body mass index explained the entire increase in prevalence of albuminuria but only part of the increase in the prevalence of decreased GFR. Estimation of GFR from serum creatinine has limited precision and a change in mean serum creatinine accounted for some of the increased prevalence of CKD. Conclusions: The prevalence of CKD in the United States in 1999-2004 is higher than it was in 1988-1994. This increase is partly explained by the increasing prevalence of diabetes and hypertension and raises concerns about future increased incidence of kidney failure and other complications of CKD.

Coresh, Josef; Selvin, Elizabeth; Stevens, Lesley A; et al.

来 源 出 版 物 ： Jama-Journal of the American Medical Association, 2007, 298(17): 2038-2047

Abstract: Context: The prevalence and incidence of kidney failure treated by dialysis and transplantation in the United States have increased from 1988 to 2004. Whether there have been changes in the prevalence of earlier stages of chronic kidney disease (CKD) during this period is uncertain. Objective: To update the estimated prevalence of CKD in the United States. Design, Setting, and Participants: Cross-sectional analysis of the most recent National Health and Nutrition Examination Surveys (NHANES 1988-1994 and NHANES 1999-2004), a nationally representative sample of noninstitutionalized adults aged 20 years or older in 1988-1994 (n=15488) and 1999-2004 (n=13233). Main Outcome Measures: Chronic kidney disease prevalence was determined based on persistent albuminuria and decreased estimated glomerular filtration rate (GFR). Persistence of microalbuminuria (＞ 30 mg/g) was estimated from repeat visit data in NHANES 1988-1994. The GFR was estimated using the abbreviated Modification of Diet in Renal Disease Study equation reexpressed to standard serum creatinine. Results: The prevalence of both albuminuria and decreased GFR increased from 1988-1994 to 1999-2004. The prevalence of CKD stages 1 to 4 increased from 10.0% (95% confidence interval [CI], 9.2%-10.9%) in 1988-1994 to 13.1% (95% CI,

被引频次：2353

National kidney foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification

Levey, AS; Coresh, J; Balk, E; et al.

Abstract: Chronic kidney disease is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of chronic kidney disease include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Current evidence suggests that some of these adverse outcomes can be prevented or delayed by early detection and treatment. Unfortunately, chronic kidney disease is underdiagnosed and undertreated, in part as a result of lack of agreement on a definition and classification of its stages of progression. Recent clinical practice guidelines by the National Kidney Foundation 1) define chronic kidney disease and classify its stages, regardless of underlying cause, 2) evaluate laboratory measurements for the clinical assessment of kidney disease, 3) associate the level of kidney function with complications of chronic kidney disease, and 4) stratify the risk for loss of kidney function and development ofcardiovascular disease. The guidelines were developed by using an approach based on the procedure outlined by the Agency for Healthcare Research and Quality. This paper presents the definition and five-stage classification system of chronic kidney disease and summarizes the major recommendations on early detection in adults. Recommendations include identifying persons at increased risk (those with diabetes, those with hypertension, those with a family history of chronic kidney disease, those older than 60 years of age, or those with U.S. racial or ethnic minority status), detecting kidney damage by measuring the albumin-creatinine ratio in untimed (“spot”) urine specimens, and estimating the glomerular filtration rate from serum creatinine measurements by using prediction equations. Because of the high prevalence of early stages of chronic kidney disease in the general population (approximately 11% of adults), this information is particularly important for general internists and specialists.来源出版物：Annals of Internal Medicine, 2003, 139(2): 137-147

被引频次：1578

Clinical epidemiology of cardiovascular disease in chronic renal disease

Foley, RN; Parfrey, PS; Sarnak, MJ

Abstract: Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The clinical epidemiology of CVD in CKD is challenging due to a prior lack of standardized defi nitions of CKD, inconsistent measures of renal function, and possible alternative effects of ‘traditional’ CVD risk factors in patients with CKD. These challenges add to the complexity of the role of renal impairment as the cause or the consequence of cardiovascular disease. The goal of this review is to summarize the current evidence on: (1) the incidence and prevalence of CVD in chronic renal insuffi ciency and in ESRD, (2) risk factors for CVD in CKD, (3) the outcomes of patients with renal failure with CVD, and (4) CKD as a risk factor for CVD. The epidemiological associations implicating the huge burden of CVD throughout all stages of CKD highlight the need to better understand and implement adequate screening, and diagnostic and treatment strategies.

来源出版物：American Journal of Kidney Diseases, 1998, 32(5):112-119被引频次：1554

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease gold executive summary

Vestbo, Jorgen; Hurd, Suzanne S; Agusti, Alvar G; et al.

Abstract: Chronic obstructive pulmonary disease (COPD) is a global health problem, and since 2001, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published its strategy document for the diagnosis and management of COPD. This executive summary presents the main contents of the second 5-year revision of the GOLD document that has implemented some of the vast knowledge about COPD accumulated over the last years. Today, GOLD recommends that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation. The document highlights that the assessment of the patient with COPD should always include assessment of (1) symptoms, (2) severity of airflow limitation, (3) history of exacerbations, and (4) comorbidities. The first three points can be used to evaluate level of symptoms and risk of future exacerbations, and this is done in a way that splits patients with COPD into four categories-A, B, C, and D. Nonpharmacologic and pharmacologic management of COPD match this assessment in an evidence-based attempt to relieve symptoms and reduce risk of exacerbations. Identification and treatment of comorbidities must have high priority, and a separate section in the document addresses management of comorbidities as well as COPD in the presence of comorbidities. The revised document also contains a new section on exacerbations of COPD. The GOLD initiative will continue to bring COPD to the attention of all relevant shareholders and will hopefully.

Keywords: COPD; clinical assessment; COPD management; exacerbations; comorbidities

来源出版物：American Journal of Respiratory and Critical Care Medicine, 2013, 187(4): 347-365

被引频次：1220

Patient self-management of chronic disease in primary care

Bodenheimer, T; Lorig, K; Holman, H; et al.

Abstract: Patients with chronic conditions make day-to-day, decisions about-self-manage-their illnesses. This reality introduces a new chronic disease paradigm: the patient-professional partnership, involving collaborativecare and self-management education. Self-management education complements traditional patient education in supporting patients to live the best possible quality of life with their chronic condition. Whereas traditional patient education offers information and technical skills, self-management education teaches problem-solving skills. A central concept in self-management is self-efficacyconfidence to carry out a behavior necessary to reach a desired goal. Self-efficacy is enhanced when patients succeed in solving patient-identified problems. Evidence from controlled clinical trials suggests that (1) programs teaching self-management skills are more effective than information-only patient education in improving clinical outcomes; (2) in some circumstances, self-management education improves outcomes and can reduce costs for arthritis and probably for adult asthma patients; and (3) in initial studies, a self-management education program bringing together patients with a variety of chronic conditions may improve outcomes and reduce costs. Self-management education for chronic illness may soon become an integral part of high-quality primary care.

来源出版物：JAMA-Journal of the American Medical Association, 2002, 287(19): 2469-2475

被引频次：1129

Depression, chronic diseases, and decrements in health: results from the World Health Surveys

Moussavi, Saba; Chatterji, Somnath; Verdes, Emese

Abstract: Background Depression is an important public-health problem, and one of the leading causes of disease burden worldwide. Depression is often comorbid with other chronic diseases and can worsen their associated health outcomes. Few studies have explored the effect of depression, alone or as comorbidity, on overall health status. Methods The WHO World Health Survey (WHS) studied adults aged 18 years and older to obtain data for health, health-related outcomes, and their determinants. Prevalence of depression in respondents based on ICD-10 criteria was estimated. Prevalence values for four chronic physical diseases-angina, arthritis, asthma, and diabeteswere also estimated using algorithms derived via a Diagnostic Item Probability Study. Mean health scores were constructed using factor analysis and compared across different disease states and demographic variables. The relation of these disease states to mean health scores was determined through regression modelling. Findings Observations were available for 245404 participants from 60 countries in all regions of the world. Overall, 1-year prevalence for ICD-10 depressive episode alone was 3.2% (95% CI 3.0-3.5); for angina 4.5% (4.3-4.8); for arthritis 4.1% (3.8-4.3); for asthma 3.3% (2.9-3.6); and for diabetes 2.0% (1.8-2.2). An average of between 9.3% and 23.0% of participants with one or more chronic physical disease had comorbid depression. This result was significantly higher than the likelihood of having depression in the absence of a chronic physical disease (P＜0.0001). After adjustment for socioeconomic factors and health conditions, depression had the largest effect on worsening mean health scores compared with the other chronic conditions. Consistently across countries and different demographic characteristics, respondents with depression comorbid with one or more chronic diseases had the worst health scores of all the disease states. Interpretation Depression produces the greatest decrement in health compared with the chronic diseases angina, arthritis, asthma, and diabetes. The comorbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression. These results indicate the urgency of addressing depression as a public-health priority to reduce disease burden and disability, and to improve the overall health of populations.

来源出版物：Lancet 2007, 370: 851-858

The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report

Chobanian, AV; Bakris, GL; Black, HR; et al.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure provides a new guideline for hypertension prevention and management. The following are the key messages: (1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (＜140/90 mm Hg or ＜130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a patent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician’s judgment remains paramount.来源出版物：JAMA-Journal of the American Medical Association, 2003, 289(19): 2560-2572被引频次：6434Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressureChobanian, AV; Bakris, GL; Black, HRAbstract: The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like itspredecessors, the purpose is to provide an evidence- based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals ( systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP ( ＜ 140/90 mm Hg, or ＜ 130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician’s judgment remains paramount.

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