Modesti Pietro Amedeo, Perruolo Eleonora, Parati Gianfranco
Department of Clinical and Experimental Medicine, University of Florence.
J Epidemiol. 2015;25(2):91-8. doi: 10.2188/jea.JE20140146. Epub 2014 Nov 22.
Hypertension is now the foremost cause of disability and is responsible for the highest percentage of attributable death among risk factors. These global changes are mainly due to the increase in the prevalence of hypertension in most low- and middle-income countries (LMICs) as a consequence of relevant socioeconomic changes occurring during the last decades. Implementation of global prevention efforts urgently needs to be accelerated because of the increasing incidence of haemorrhagic stroke, renal failure, and hypertensive heart disease in developing countries. Blood pressure (BP) measurement has different implications in epidemiological studies performed in low-resource settings. First, the frequency of blood pressure measurement is a simple but reliable indicator of access to healthcare in epidemiological studies, which may disclose the favourable effects of urbanization; the opportunity to have BP measured increases hypertension awareness, facilitates drug treatment, and leads to better achievement of BP control. Second, BP measurement is a key element in cardiovascular risk stratification, focusing solely on the preferred strategy in low-resource settings where costs of biochemical tests might be less sustainable. Third, the issue of obtaining reliable estimation of BP values is crucial to achieve sound data on the burden of hypertension in LMICs, and some aspects of BP measurement, such as the use of reliable automated devices, the number of measurements/visits to achieve a consistent diagnosis of hypertension, and the possible confounding effect of environmental factors, must be closely considered.
高血压现已成为导致残疾的首要原因，在所有风险因素中，其导致的归因死亡占比最高。这些全球性变化主要是由于过去几十年中相关社会经济变化，导致大多数低收入和中等收入国家（LMICs）高血压患病率上升。由于发展中国家出血性中风、肾衰竭和高血压性心脏病的发病率不断上升，迫切需要加快全球预防工作的实施。在资源匮乏地区进行的流行病学研究中，血压（BP）测量具有不同的意义。首先，血压测量频率是流行病学研究中获得医疗服务的一个简单但可靠的指标，它可能揭示城市化的有利影响；测量血压的机会可提高高血压知晓率，促进药物治疗，并有助于更好地实现血压控制。其次，血压测量是心血管风险分层的关键要素，在资源匮乏地区，当生化检测成本可能难以持续时，应仅关注首选策略。第三，获得可靠的血压值估计对于获取关于低收入和中等收入国家高血压负担的可靠数据至关重要，必须密切考虑血压测量的一些方面，如使用可靠的自动设备、为实现高血压的一致诊断所需的测量次数/就诊次数，以及环境因素可能产生的混杂效应。
