Volpe Massimo, Alderman Michael H, Furberg Curt D, Jackson Rodney, Kostis John B, Laragh John H, Psaty Bruce M, Ruilope Luis M
Department of Cardiology, II Faculty of Medicine, University of Rome La Sapienza Rome, Rome, Italy.
Am J Hypertens. 2004 Nov;17(11 Pt 1):1068-74. doi: 10.1016/j.amjhyper.2004.06.017.
Most current clinical guidelines focus primarily on the management of individual cardiovascular risk factors, such as high blood pressure (BP), hypercholesterolemia, or diabetes. A more appropriate clinical approach to reducing cardiovascular disease risk would be based on a comprehensive evaluation of risk profile, and accurate stratification of global (absolute) risk in individual patients. We propose that global risk should be used as the main determinant of whom to treat, how to treat, and how much to treat.
In this article we use a series of case studies to demonstrate the implications of replacing the traditional "single risk factor-based" approach to managing hypertension by one based on global risk assessment. In some situations patients with mildly elevated BP levels would not be recommended for antihypertensive drug treatment whereas others with lower BP would be treated, depending upon the entire risk profile.
We propose to replace the single risk factor-based approach with the assessment of global cardiovascular risk, both in the clinical management of individual patients and in guidelines.
当前大多数临床指南主要侧重于对个体心血管危险因素的管理，如高血压、高胆固醇血症或糖尿病。一种更合适的降低心血管疾病风险的临床方法应基于对风险状况的全面评估以及对个体患者总体（绝对）风险的准确分层。我们建议将总体风险用作决定治疗对象、治疗方式及治疗强度的主要决定因素。
在本文中，我们使用一系列案例研究来证明用基于总体风险评估的方法取代传统的“基于单一危险因素”的高血压管理方法所产生的影响。在某些情况下，血压轻度升高的患者可能不建议进行抗高血压药物治疗，而其他血压较低的患者则会接受治疗，这取决于整体风险状况。
我们建议在个体患者的临床管理和指南中，用总体心血管风险评估取代基于单一危险因素的方法。
