護理師在社區進行血壓篩檢。依 ACC/AHA 血壓分級，哪一個讀值屬於第二期高血壓（stage 2 hypertension），需盡速轉介醫療提供者評估？
A nurse is conducting a community blood pressure screening. Based on the ACC/AHA blood pressure categories, which reading falls into the stage 2 hypertension category and requires prompt referral to a provider?
- A118/76 mmHg
- B146/92 mmHg正確答案
- C126/78 mmHg
- D134/86 mmHg
- B146/92 mmHg
正確答案是 B。2017 ACC/AHA 血壓分級（2025 AHA/ACC 指引沿用）：正常為收縮壓 <120 且舒張壓 <80 mmHg；血壓升高（elevated）為收縮壓 120–129 且舒張壓 <80；第一期高血壓為收縮壓 130–139 或舒張壓 80–89；第二期高血壓為收縮壓 ≥140 或舒張壓 ≥90。146/92 mmHg 的收縮壓與舒張壓都達第二期標準。指引建議第二期高血壓者應開始生活型態調整並啟用降壓藥物，篩檢站發現後應轉介醫療提供者，並以不同場合的多次讀值確認診斷；量測前應避免剛運動、咖啡因與吸菸。A：118/76 為正常血壓，給予一般健康促進衛教。C：126/78 屬血壓升高，建議生活型態調整並在 3–6 個月內複測。D：134/86 屬第一期高血壓，需依心血管風險決定生活型態調整或用藥，但不屬於第二期。來源：2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults（Whelton 等）；2025 AHA/ACC High Blood Pressure Guideline。
- A118/76 mmHg
錯誤。118/76 mmHg 屬正常血壓（收縮壓 <120 且舒張壓 <80），只需一般健康促進衛教。
- B · 正確答案146/92 mmHg
正確。146/92 mmHg 的收縮壓 ≥140 且舒張壓 ≥90，符合第二期高血壓，需盡速轉介醫療提供者評估並考慮藥物治療。
- C126/78 mmHg
錯誤。126/78 mmHg 屬血壓升高（收縮壓 120–129 且舒張壓 <80），建議生活型態調整並於 3–6 個月內複測，不是第二期。
- D134/86 mmHg
錯誤。134/86 mmHg 屬第一期高血壓（收縮壓 130–139 或舒張壓 80–89），需追蹤與風險評估，但未達第二期標準。
台灣高血壓學會與中華民國心臟學會 2022 年指引已將高血壓定義下修為 130/80 mmHg，並以居家血壓（722 原則）作為診斷與治療目標依據，與美國 ACC/AHA 的 130/80 閾值一致；但美國另設「血壓升高」與第一、二期分級，台灣臨床較少使用分期名詞。
English explanation
Option B is correct. The 2017 ACC/AHA blood pressure categories, retained in the 2025 AHA/ACC guideline, are: normal, systolic less than 120 and diastolic less than 80 mmHg; elevated, systolic 120 to 129 and diastolic less than 80; stage 1 hypertension, systolic 130 to 139 or diastolic 80 to 89; and stage 2 hypertension, systolic 140 or higher or diastolic 90 or higher. A reading of 146/92 mmHg meets stage 2 criteria on both values. The guideline recommends lifestyle changes plus antihypertensive medication for stage 2 hypertension, so the nurse refers the client for prompt evaluation and explains that the diagnosis is confirmed with repeated readings on separate occasions, avoiding measurement right after exercise, caffeine, or smoking. Option A is incorrect because 118/76 mmHg is normal and calls only for general health promotion. Option C is incorrect because 126/78 mmHg is elevated blood pressure, managed with lifestyle changes and reassessment in 3 to 6 months. Option D is incorrect because 134/86 mmHg is stage 1 hypertension, managed according to cardiovascular risk, but it is not stage 2. Source: 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (Whelton et al.); 2025 AHA/ACC High Blood Pressure Guideline.