现实的治疗高血压之道 Research underlines benefits of lowering blood pressure

High blood pressure is one of the main causes of heart disease, stroke and premature death in Europe and North America, with about one in three adults afflicted by the condition.

在欧洲和北美，高血压是导致心脏病、中风和过早死亡的主要原因之一，约三分之一的成年人患有高血压。

There are 152,000 strokes in the UK alone each year, resulting in 41,000 deaths, according to the National Health Service, yet an estimated 30 per cent of people who have high blood pressure don’t even know they have a problem.

英国国民健康服务(NHS)的数据显示，英国每年发生中风15.2万例，导致4.1万人死亡。不过，约30%的高血压患者甚至不知自己身体有恙。

Under current guidelines in Europe, people are considered to have high blood pressure, known medically as hypertension, if their systolic blood pressure, the first of two numbers usually recorded, is above 140mm Hg, or millimetres of mercury.

根据欧洲现行的参考指标，如果一个人的收缩压高于140毫米汞柱(mm Hg)——通常记录的两项血压值中的前一项——就可认为患有高血压（医学名为hypertension）。

But a study released in the US last month may force doctors to rethink their approach to the problem.

但上月美国发表的一项研究成果，或许会迫使医生们反思治疗高血压的方法。

The National Institutes of Health study, known as the systolic blood pressure intervention trial (Sprint), followed 9,300 people who were over the age of 50. The trial found that people given medication to lower their blood pressure to 120mm Hg, or 20mm Hg below the previous target, suffered a third fewer heart attacks, heart failure and strokes than control groups. The risk of death declined by a quarter.

美国国立卫生研究院（National Institutes of Health，简称NIH）的这项名为“收缩压干预试验”(Sprint)的研究，追踪了9300名50岁以上的研究对象。试验发现，通过服药把血压降到120mm Hg、或者比之前目标低20mm Hg的人，心脏病发作、心力衰竭和中风的概率比对照组少三分之一。死亡风险下降了四分之一。

The study was so successful that it was ended a year earlier than planned.

研究非常成功，比预期提前一年便结束了。

The problem is that in order to reach these reduced levels, patients were given a cocktail of three medications. When I asked Paul Thompson, a cardiologist in Hartford, Connecticut, if he has changed his treatment for hypertension as a result, he says “not really”. The main reason, he notes, is the difficulty in getting patients to adhere to such a complicated drug regimen.

问题在于，为了把血压降到上述水平，患者需要服用三种药物。当我询问康涅狄格州哈特福特的心血管专家保罗搠湬森(Paul Thompson)，他是否因此改变了高血压治疗方法时，他说，“没有”。他指出，主要原因在于，让患者遵循如此复杂的服药方案是有难度的。

“We always have to remember that folks in studies are different from folks in the office,” Dr Thompson says.

“我们始终必须记住，研究对象跟办公室里的人是不同的，”汤普森说。

When I ask the same question of Rhian Touyz, the director of the Institute of Cardiovascular and Medical Science at the University of Glasgow, she says she is awaiting the full results of the Sprint study, which will be formally presented at a conference in Florida next month, before making any change in recommendations in medications.

当我向格拉斯哥大学(University of Glasgow)心血管和医学科学研究所(Cardiovascular and Medical Science)所长里安堠志(Rhian Touyz)提出相同问题时，她说，她在等待Sprint研究项目的完整结果——将于下个月在佛罗里达州的一次大会上正式公布——然后才会决定是否对用药建议进行更改。

However, Professor Touyz does note that lifestyle changes are the first line of defence against hypertension.

不过托志教授指出，改变生活方式是对抗高血压的第一道防线。

One of the biggest contributors to high blood pressure is the large amount of salt in western diets, not only what we add from the shaker but what is hidden in prepackaged foods and beverages such as breakfast cereals and sports drinks.

造成高血压的最重要因素之一，是西方饮食中盐的含量偏高，不但有我们用调味瓶添加的盐，还有隐藏在预包装食品和饮料（比如早餐谷物和运动饮料）中的盐。

It has been known for 50 years that people who eat a low salt diet (under 2g a day) are free from the blood pressure problems common in western industrial countries.

在西方工业国家，血压问题很常见。而人们50年前就知道，低盐饮食（每日低于2克）的人不会出血压问题。

The NHS recommends eating no more than 6g of salt, or 2.4g of sodium a day.

NHS建议，每日盐摄入量不要超过6克，也就是说，钠摄入量不超过2.4克。

Prof Touyz says that cutting salt intake is only one of several lifestyle changes she recommends. The others include exercising four times a week for 30-40 minutes, cutting alcohol consumption and eating a diet high in fruit and vegetables.

托志教授表示，减少盐摄入量只是通过改变生活方式降低血压的几种建议之一。其他还包括每周锻炼四次、每次30至40分钟，少喝酒，多吃水果和蔬菜。

So get your blood pressure checked. For those who have high blood pressure, it would help to increase consumption of kale, spinach, beets and beetroot juice, which are rich in nitrates. The nitrates become nitric oxide in the body, which is a natural dilator of blood vessels, significantly lowering blood pressure.

所以，把你的血压控制住。对于高血压患者，多摄入羽衣甘蓝、菠菜、甜菜和甜菜根汁等富含硝酸盐的食物是有好处的。硝酸盐在人体内会变成一氧化氮，一氧化氮是天然的血管扩张器，能够明显降低血压。