Volpe Massimo, Tocci Giuliano
Division of Cardiology, II Faculty of Medicine, University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.
J Hypertens Suppl. 2009 Jun;27(3):S3-11. doi: 10.1097/01.hjh.0000356766.86388.e5.
Clinical evaluation of cardiovascular risk in patients with hypertension is evolving from independently assessing well-known, traditional risk factors (e.g. hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking) towards an integrated, multidisciplinary clinical approach, aimed at determining the global (or total) cardiovascular risk profile in each individual patient for planning early and effective strategies for cardiovascular prevention. A paradigmatic example is provided by hypertension, in which new clinical behaviour implies a shift from focusing only on high blood pressure levels towards a more integrated approach, aimed at identifying and reducing global cardiovascular risk, as is highlighted in the European Guidelines. This approach arises from the acknowledgement that a cluster of cardiovascular risk factors is the rule, rather than the exception in hypertension. In addition, major cardiovascular diseases often develop from a subclinical level, which can be discovered at an early stage, thus providing the opportunity promptly to intercept and treat high-risk patients early. Identification of organ damage and assessment of hypertension-related clinical conditions can further contribute to a more precise definition of an individual total cardiovascular risk profile, and to the decision on when, how and how much to treat patients with hypertension. Implementing a clinical behaviour based on global cardiovascular risk assessment will help to target global cardiovascular risk reduction, while maintaining specific therapeutic goals for individual risk factors. This synergistic approach holds the best promise for treating total cardiovascular risk and reducing the mounting global burden of cardiovascular disease associated with hypertension.
高血压患者心血管风险的临床评估正从独立评估众所周知的传统风险因素（如高血压、高胆固醇血症、肥胖、糖尿病、吸烟），向一种综合的多学科临床方法转变，该方法旨在确定每个患者的整体（或总）心血管风险状况，以便制定早期有效的心血管预防策略。高血压就是一个典型例子，其中新的临床行为意味着从仅关注高血压水平转向更综合的方法，旨在识别和降低整体心血管风险，正如欧洲指南中所强调的那样。这种方法源于这样一种认识，即心血管风险因素的聚集在高血压中是常态而非例外。此外，主要心血管疾病往往从亚临床阶段发展而来，早期可以发现，从而为及时拦截和早期治疗高危患者提供了机会。识别器官损害和评估与高血压相关的临床状况，可进一步有助于更精确地定义个体的整体心血管风险状况，并有助于决定何时、如何以及对高血压患者进行何种程度的治疗。基于全球心血管风险评估实施临床行为，将有助于针对降低整体心血管风险，同时保持针对个体风险因素的特定治疗目标。这种协同方法最有希望治疗整体心血管风险，并减轻与高血压相关的日益增加的全球心血管疾病负担。
