Strategies for prevention of cardiovascular disease in adults with hypertension.
Strategies for prevention of cardiovascular disease in adults with hypertension.
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成人高血压患者预防心血管疾病的策略。
DOI：
10.1111/jch.13797
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Zhang,Xin-Hua
中科院分区：
文献类型：
--
作者：
Whelton,PaulK;Campbell,NormRC;Lackland,DanielT;Parati,Gianfranco;Ram,CVenkataS;Weber,MichaelA;Zhang,Xin-Hua
《柳叶刀》杂志最近发表了一篇题为“高血压作为一种疾病的概念是无益的吗？"的社论，提出了关于预防血压（BP）相关心血管疾病（CVD）的最佳方法的问题。[1]最初，该社论提请注意这样一个事实，即高血压的认识、治疗和控制（收缩压[SBP]≥ 140 mm Hg，舒张压[DBP]≥ 90 mm Hg或抗高血压药物治疗）在全球范围内都是不够的，尤其是在中低收入国家。这是根据同一期发表的两份报告得出的。2，3虽然令人不安，但这两篇文章中的发现并不令人惊讶。基于代表性样本的既往报告显示，全球范围内血压升高和高血压的患病率较高且不断增加，4，5高血压的认识、治疗和控制不足，特别是在低收入和中等收入国家，米尔斯等人4估计，2010年只有7.7%的高血压成人接受治疗并控制收缩压< 140 mm。Geldsetzer et al在方法和时间轴上的差异与低收入和中等收入国家10.3%的知晓率、治疗率和控制率的估计值相似。社论接着提出了一个问题：“那么，高血压作为一种疾病的概念，尽管阈值不断变化，但它实际上是没有帮助的吗？”关于CVD风险降低是否最好通过关注预先存在的（潜在的）CVD风险，高水平的个体CVD风险因素（包括高血压）或两者兼而有之来实现的争论并不新鲜。6《柳叶刀》社论引用了Herrett等人的回顾性分析，该分析模拟了以下四种降血压策略对CVD负担的潜在影响：基于（a）BP阈值的治疗（SBP/DBP≥ 140/90 mm Hg），（B）2011年国家健康与护理卓越研究所（NICE）指南中CVD风险和BP阈值的组合，（c）2019年NICE指南中CVD风险和BP阈值的组合，与2011年指南相比，该指南采用了较低的CVD风险估计阈值，以及（d）CVD风险估计阈值。7在英国，符合治疗条件的成年人百分比、每1000观察患者年的CVD相关发生率以及在略多于4年的时间内可以预防的CVD事件的预期数量分别为22.2%、15.2%和271963，使用2011年NICE指南阈值，分别为26.8%、14.9%、271963。使用2019年NICE指南阈值，分别为327 429人，使用BP阈值，分别为39.4%、11.4%和301 523人，使用CVD风险估计阈值，分别为29.3%、16.9%和322 921人。总之，预测每种方法都是有益的，CVD风险估计（单独）被确定为CVD预防的最佳方法，与其他方法相比，
A recent editorial in The Lancet, entitled “Is the concept of hypertension as a disease unhelpful?”, raises questions regarding the optimal approach to prevention of blood pressure (BP)-related cardiovascular disease (CVD). 1 Initially, the editorial called attention to the fact that awareness, treatment, and control of hypertension (systolic BP [SBP]≥ 140 mm Hg, diastolic BP [DBP]≥ 90 mm Hg or treatment with antihypertensive drug therapy) is inadequate worldwide but especially so in middle-and low-income countries. This was based on two reports published in the same issue. 2, 3 While disturbing, the findings in these two articles are not surprising. Previous reports, based on representative samples, have reported a high and increasing prevalence of elevated BP and hypertension worldwide, 4, 5 and inadequate awareness, treatment, and control of hypertension, especially in low-and middle-income countries where Mills et al4 estimated that only 7.7% of adults with hypertension were being treated and controlled to a systolic BP< 140 mm in 2010. Recognizing differences in methods and timeline, the 10.3% estimate of awareness, treatment, and control in low-and middle-income countries by Geldsetzer et al is similar.The editorial goes on to ask the question “So, is the concept of hypertension as a disease with defined, albeit changing thresholds actually unhelpful?” The debate as to whether CVD risk reduction is best achieved by a focus on pre-existing (underlying) CVD risk, high levels of individual CVD risk factors, including high BP, or both is not new. 6 The Lancet editorial cites a retrospective analysis by Herrett et al which modeled the potential effect of the four following BP-lowering strategies on burden of CVD: Treatment based on (a) a BP threshold (SBP/DBP≥ 140/90 mm Hg),(b) the 2011 National Institute for Health and Care Excellence (NICE) guideline combination of CVD risk and BP thresholds,(c) the 2019 NICE guideline combination of CVD risk and BP thresholds, which employs a lower threshold for estimated CVD risk compared to the 2011 guideline, and (d) a CVD risk estimation threshold. 7 The percentages of adults eligible for treatment, associated rate of CVD per 1000 patient-years of observation, and expected number of CVD events that would be prevented during slightly more than 4 years in the United Kingdom were 22.2%, 15.2%, and 271 963 using the 2011 NICE guideline thresholds, 26.8%, 14.9%, and 327 429 using the 2019 NICE guideline thresholds, 39.4%, 11.4%, and 301 523 using the BP threshold, and 29.3%, 16.9%, and 322 921 using the CVD risk estimation threshold. In summary, each approach was predicted to be beneficial with CVD risk estimation (alone) being identified as the best approach to CVD prevention, with a slight advantage compared
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影响因子：
5.9
作者：
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通讯作者：
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影响因子：
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通讯作者：
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DOI：
--
发表时间：
2010
期刊：
--
影响因子：
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作者：
通讯作者：
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