參與JNC 8的專家們發表之2014年高血壓指引報告

Review of the 2014 Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)

賴奇正(Chi-Cheng Lai) ； 馬光遠(Guang-Yuan Mar) ； 邱春旺(Chuen-Wang Chiou) ； 劉俊鵬(Chun-Peng Liu)

《內科學誌》 25卷3期 (2014/06) Pp. 165-175

https://doi.org/10.6314/JIMT.2014.25(3).06

摘要

高血壓是臨床上常見的病況，也是心臟血管疾病重要的危險因子之一，血壓控制不良會增加心肌梗塞、中風、腎臟衰竭、和死亡的風險。有效地控制高血壓可以降低心臟血管及腎臟不良事件的發生。自從2003年美國JNC 7高血壓指引（the Seventh Joint National Committee hypertension guideline）發表至今已超過10年，負責制定高血壓指引的美國國家公立機構National Heart, Lung, and Blood Institute（NHLBI），雖然制定JNC 8過程緩慢，但官網上仍有公告JNC 8制定的進度。但NHLBI於去年（2013年）中宣佈不再制定臨床指引，其中也包括終止JNC 8制定過程。被指定參與JNC 8制定的專家學者們，仍於去年12月在文獻網路上公開發表一篇名為2014年以實證為基礎的高血壓處置指引報告，篇幅總共有14頁，引用45篇的參考文獻，首先提出三個重要的高血壓臨床問題，針對這三個問題，這些專家學者回顧檢視（review）具有證據力的隨機分派有對照研究文獻，最後提出九項建議及其證據等級強度，並將檢視的過程及考慮，詳細地說明。本組以中文簡介及分析此指引報告，期望本文能將此高血壓指引的精髓，提供給更多國內醫師同好了解，做為治療高血壓病患的參考。

關鍵字

血壓（Blood pressure） ； 高血壓治療（Hypertension treatment） ； 高血壓指引（Hypertension guideline） ； JNC 8（The Eighth Joint National Committee）

並列摘要

Hypertension is one of common diseases and important risk factors for cardiovascular disease. Uncontrolled hypertension leads to increased risks of myocardial infarction, stroke, renal failure, and death. Effective blood pressure control improves cardiovascular and renal outcomes. The seventh Joint National Committee (JNC 7) hypertension guideline was published ten years ago, in 2003. However, the National Heart, Lung, and Blood Institute (NHLBI) which was in charge of developing clinical guidelines in the U.S. announced the decision to discontinue developing clinical guidelines including the JNC 8 guideline in process. The panel members appointed to the JNC 8 guideline published a report online in JAMA last December entitled as ＂2014 evidence-based guideline for the management of high blood pressure in adults＂. The article contains 14 pages and 45 references. The evidence of selected randomized controlled trials was reviewed focused upon three major clinical questions in hypertension management. The guideline finally suggests nine recommendations and their evidence strengthens, and as well details each of the recommendations and the review process. Our author team introduces the key points of the report in Chinese to the domestic readers who are interested in the topic. The review article is expected to help treat the patients with hypertension.