ESH/ESC高血压防治指南2007版将在意大利米兰召开的第十七届欧洲高血压年会上公布，现摘选指南的部分内容供大家浏览。

高血压定义和分类：
以往我们主要把舒张压作为心血管疾病和致死性事件的预测因子。JNC指南中，高血压的分类时未考虑收缩压，并且未将收缩压和舒张压联系起来…

 2. Definition and classification of hypertension
 Historically more emphasis was placed on diastolic than on systolic blood pressure as a predictor of cardiovascular morbid and fatal events [7]. This was reflected in the early guidelines of the Joint National Committee which did not consider systolic blood pressure and isolated systolic hypertension in the classification of hypertension [8，9]. It was reflected further in the design of early randomized clinical trials which almost invariably based patient recruitment criteria on diastolic blood pressure values [10]. However， a large number of observational studies has demonstrated that cardiovascular morbidity and mortality bear a continuous relationship with both systolic and diastolic blood pressures [7，11]. The relationship has been reported to be less steep for coronary events than for stroke which has thus been labelled as the most important ‘‘hypertension related’’ complication [7]. However， in several regions of Europe， though not in all of them， the attributable risk， that is the excess of death due to an elevated blood pressure， is greater for coronary events than for stroke because heart disease remains the most common cardiovascular disorder in these regions [12]. Furthermore， both systolic and diastolic blood pressures show a graded independent relationship with heart failure， peripheral artery disease and end stage renal disease [13–16]. Therefore， hypertension should be considered a major risk factor for an array of cardiovascular and related diseases as well as for diseases leading to a marked increasein cardiovascular risk. This， and the wide prevalence of high blood pressure in the population [17–19]， explain why in a WHO report high blood pressure has been listed as the first cause of death worldwide [20].

2.1 Systolic versus diastolic and pulse pressure
In recent years the simple direct relationship of cardiovascular risk with systolic and diastolic blood pressure has been made more complicated by the findings of observational studies that in elderly individuals the risk is directly proportional to systolic blood pressure and， for any given systolic level， outcome is inversely proportional to diastolic blood pressure [21–23]，with a strong predictive value of pulse pressure (systolic minus diastolic) [24–27]. The predictive value of pulse pressure may vary with the clinical characteristics of the subjects. In the largest metaanalysis of observational data available today(61 studies in almost 1 million subjects without overt cardiovascular disease， of which 70% are from Europe) [11] both systolic and diastolic blood pressures were independently and similarly predictive of stroke and coronary mortality， and the contribution of pulse pressure was small， particularly in individuals aged less than 55 years. By contrast， in middle aged [24，25] and elderly [26，27] hypertensive patients with cardiovascular risk factors or associated clinical conditions，pulse pressure showed a strong predictive value for cardiovascular events [24–27].
It should be recognized that pulse pressure is a derived measure which combines the imperfection of the original measures. Furthermore， although figures such as 50 or 55mmHg have been suggested [28]， no practical cutoff values separating pulse pressure normality from abnormality at different ages have been produced. As discussed in section 3.1.7 central pulse pressure， which takes into account the ‘‘amplification phenomena’’ between the peripheral arteries and the aorta， is a more precise assessmentand may improve on these limitations.
In practice， classification of hypertension and risk assessment (see sections 2.2 and 2.3) should continue to be based on systolic and diastolic blood pressures. This should be definitely the case for decisions concerning the blood pressure threshold and goal for treatment， as these have been the criteria employed in randomized controlled trials on isolated systolic and systolic- diastolic hypertension. However， pulse pressure may be used to identify elderly patients with systolic hypertension who are at a particularly high risk. In these patients a high pulse pressure is a marker of a pronounced increase of large artery stiffness and therefore advanced organ damage [28] (see section 3.6).

（摘自Journal of Hypertension 2007， 25:1105–1187）