現實的治療高血壓之道 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.

在歐洲和北美，高血壓是導致心臟病、中風和過早死亡的主要原因之一，約三分之一的成年人患有高血壓。

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.

英國國民健康服務(NHS)的數據顯示，英國每年發生中風15.2萬例，導致4.1萬人死亡。不過，約30%的高血壓患者甚至不知自己身體有恙。

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.

根據歐洲現行的參考指標，如果一個人的收縮壓高於140毫米汞柱(mm Hg)——通常記錄的兩項血壓值中的前一項——就可認爲患有高血壓（醫學名爲hypertension）。

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

但上月美國發表的一項研究成果，或許會迫使醫生們反思治療高血壓的方法。

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.

美國國立衛生研究院（National Institutes of Health，簡稱NIH）的這項名爲“收縮壓干預試驗”(Sprint)的研究，追蹤了9300名50歲以上的研究對象。試驗發現，通過服藥把血壓降到120mm Hg、或者比之前目標低20mm Hg的人，心臟病發作、心力衰竭和中風的概率比對照組少三分之一。死亡風險下降了四分之一。

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

研究非常成功，比預期提前一年便結束了。

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.

問題在於，爲了把血壓降到上述水平，患者需要服用三種藥物。當我詢問康涅狄格州哈特福特的心血管專家保羅搠湬森(Paul Thompson)，他是否因此改變了高血壓治療方法時，他說，“沒有”。他指出，主要原因在於，讓患者遵循如此複雜的服藥方案是有難度的。

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

“我們始終必須記住，研究對象跟辦公室裏的人是不同的，”湯普森說。

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.

當我向格拉斯哥大學(University of Glasgow)心血管和醫學科學研究所(Cardiovascular and Medical Science)所長裏安堠志(Rhian Touyz)提出相同問題時，她說，她在等待Sprint研究項目的完整結果——將於下個月在佛羅里達州的一次大會上正式公佈——然後纔會決定是否對用藥建議進行更改。

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

不過託志教授指出，改變生活方式是對抗高血壓的第一道防線。

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.

造成高血壓的最重要因素之一，是西方飲食中鹽的含量偏高，不但有我們用調味瓶添加的鹽，還有隱藏在預包裝食品和飲料（比如早餐穀物和運動飲料）中的鹽。

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.

在西方工業國家，血壓問題很常見。而人們50年前就知道，低鹽飲食（每日低於2克）的人不會出血壓問題。

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

NHS建議，每日鹽攝入量不要超過6克，也就是說，鈉攝入量不超過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.

託志教授表示，減少鹽攝入量只是通過改變生活方式降低血壓的幾種建議之一。其他還包括每週鍛鍊四次、每次30至40分鐘，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，把你的血壓控制住。對於高血壓患者，多攝入羽衣甘藍、菠菜、甜菜和甜菜根汁等富含硝酸鹽的食物是有好處的。硝酸鹽在人體內會變成一氧化氮，一氧化氮是天然的血管擴張器，能夠明顯降低血壓。