Achievement of cardiometabolic goals in aware hypertensive patients in Spain: implications for population health.
Achievement of cardiometabolic goals in aware hypertensive patients in Spain: implications for population health.
复制标题
西班牙意识高血压患者实现心脏代谢目标：对人口健康的影响。
DOI：
10.1161/hypertensionaha.112.198994
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Egan,BrentM
中科院分区：
文献类型：
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作者：
Egan,BrentM
美国公共卫生工作的失败，至少在心脏健康的生活方式方面，被对大众实施医疗高风险策略所取代。换句话说，血压、血脂和葡萄糖的治疗水平逐渐降低，这些风险因素中有≥ 1个影响大多数成人，而不是5%至10%。在由于不健康的生活方式而导致风险不断增加的人群中，用适用于大众的医疗高风险策略取代公共卫生大众策略，导致在提高人群对多种心血管风险因素的认识、治疗、监测和控制方面做出了重大努力。如临床流行病学数据所示，这种方法成本高昂，并且容易在几个点上失败（表1）。1-3如果要实现促进健康和预防疾病的目标，而不开展有效的公共卫生大众战略运动，那么就需要医疗管理来降低风险水平。16在资源有限的情况下，可以通过重新启动公共卫生/大众战略方法13和/或过渡到更有效、成本更低的医疗干预措施来减少全球心脏病风险，例如，对大多数成年人使用最少医疗监测的复方药丸，来促进人口健康。[16] Banegas等人的研究1记录了西班牙高血压患者的全球心血管风险水平较高，占所有成年人的三分之一。另外三分之一的成年人可能处于高血压前期，患心血管疾病的风险比血压正常的成年人高50%至100%。14基于人口的数据突出表明，需要认真考虑实施负担得起的、有效的和可持续的公共卫生大众战略，以及高效和有效的医疗保健提供系统（医疗战略），以减少日益增长的全球心脏代谢风险和疾病负担。
The unsuccessful public health effort in the United States, at least with regard to heart healthy lifestyles, was replaced by applying the medical high-risk strategy to the masses. In other words, the levels at which blood pressure, lipids, and glucose are treated have moved to progressively lower levels with≥ 1 of these risk factors impacting the majority of adults rather than the upper 5% to 10%. Substituting a medical highrisk strategy applied to the masses for a public health mass strategy in a population with ever increasing risk because of unhealthy lifestyle patterns has resulted in major efforts to raise the awareness, treatment, monitoring, and control of multiple cardiovascular risk factors in the population. Such an approach is costly and susceptible to failure at several points as the clinical epidemiological data show (Table 1). 1-3 If health promotion and disease prevention goals are to be achieved15 without an effective public health mass strategy campaign, then ever lower levels of risk will require medical management. 16 Given constrained resources, population health can be advanced by re-energizing the public health/mass strategy approach13 and/or transitioning to more efficient, less costly medical interventions for reducing global cardiometatolic risk, for example, a polypill with minimal medical monitoring for most adults. 16The work by Banegas et al1 documents the high level of global cardiovascular risk among hypertensive patients in Spain, composed of one third of all adults. Another third of adults are likely prehypertensive and have cardiovascular disease risk 50% to 100% greater than adults with normal BP. 14 The population-based data highlight a major need for serious deliberations to effect an affordable, effective, and sustainable public health mass strategy, as well as highly efficient and effective healthcare delivery systems (medical strategy) to reduce the growing global burden of cardiometabolic risk and disease.