积极降压对脑小血管病防治策略的影响

2017年，美国心脏病学会和美国心脏协会提出将高血压诊断标准降为130/80 mm Hg(1 mm Hg=0.133 kPa)，这与其他指南有所不同。降压治疗的核心目标在于靶器官的保护，近年来降压治疗与脑小血管病预防的相关问题日益受到临床重视。目前研究结果表明, 降压治疗对腔隙性卒中患者的二级预防以及白质病变进展的预防可能有一定积极意义，但确切的降压目标值并未确定。血压与临床结局可能呈现J型关系，血压过低或过高可能均有害，而取得最大获益的降压目标有待进一步探索。

Effect of Antihypertensive Program on the Prevention and Treatment of Cerebral Small Vessel Disease

Recently, ACC/AHA has proposed the new diagnostic criteria of hypertension as130/80 mm Hg (1 mm Hg=0.133 kPa), which is different from other guidelines. The core goal of antihypertensive therapy is the protection of target organs. Therefore, the issues related to intensive antihypertensive therapy and the prevention of cerebral small vessel disease have attracted more attention in recent years. Current findings suggest that the antihypertensive program may have a positive effect on secondary prevention of lacunar stroke and white matter lesions. The exact target blood pressure (BP) has not been determined yet. BP and clinical outcomes may present a J-type relationship, indicating that too low or too high BP may both be harmful, and the ideal target BP is to be further explored.