Off the cuff: rebooting blood pressure treatment.
Off the cuff: rebooting blood pressure treatment.
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即兴：重新启动血压治疗。
DOI：
10.1016/s0140-6736(16)31348-4
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Topol,EricJ
中科院分区：
文献类型：
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作者：
Steinhubl,StevenR;Muse,EvanD;Barrett,PaddyM;Topol,EricJ
血压计在大约120年前首次引入临床实践，几十年后高血压作为一种疾病的概念也随之出现。抗高血压药物又花了几十年的时间才出现，今天有近十几种单独的降压药物。然而，尽管诊断和治疗高血压的基本工具已有半个多世纪，但高血压仍然是全球发病率和死亡率的主要原因之一，造成这一问题的原因有很多，包括需要更好地认识生活方式和环境因素，制定促进健康行为的政策，以及普及负担得起的抗高血压药物。另一个关键问题是，我们对“正常”血压还没有明确的认识。这主要是由于基于袖带的血压确定的相当麻烦的行为，其主要将血压监测降级为诊所中的一次性测量。这种方法使我们无法理解夜间与白天的血压，每天甚至每分钟的变化，以及多年和几十年的血压轨迹。此外，没有足够的护理系统来识别和适当管理高血压患者或高风险患者。全球许多高血压患者的血压没有得到充分控制。这部分是由于许多患者的高血压未被诊断，但也因为只有约三分之一的确诊患者得到充分控制。
The sphygmomanometer was first introduced into clinical practice some 120 years ago, followed decades later by the concept of high blood pressure as a disease. It took several more decades before antihypertensive medications became available, and today there are nearly a dozen individual classes of blood pressure-lowering drugs. Yet despite having the basic tools necessary to diagnose and treat hypertension for over half a century, high blood pressure remains one of the leading contributors to morbidity and mortality worldwide.There are many reasons for this problem, including the need for better awareness of lifestyle and environmental factors, policies that promote healthy behaviours, and universal access to affordable antihypertensive drugs. Another key issue is that we don't yet have a clear understanding of “normal” blood pressure. This is mainly due to the fairly cumbersome act of cuff-based blood pressure determination, which has mostly relegated blood pressure monitoring to one-off measurements in a clinic. This approach prevents us from understanding night-time versus daytime blood pressure, day-to-day or even minute-to-minute variability, and blood pressure trajectories over years and decades. Additionally, there are inadequate systems of care to enable the identification and proper management of individuals with hypertension or those at high risk. Many people with hypertension globally do not have their blood pressure adequately controlled. This is partly due to the fact that hypertension is undiagnosed in many patients, but also because only about a third of those diagnosed are adequately controlled.