Savoia Carmine, Volpe Massimo, Grassi Guido, Borghi Claudio, Agabiti Rosei Enrico, Touyz Rhian M
Clinical and Molecular Medicine Department, Cardiology Unit Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
Clinical and Molecular Medicine Department, Cardiology Unit Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Clin Sci (Lond). 2017 Nov 6;131(22):2671-2685. doi: 10.1042/CS20160407. Print 2017 Nov 15.
The main goal of treating hypertension is to reduce blood pressure to physiological levels and thereby prevent risk of cardiovascular disease and hypertension-associated target organ damage. Despite reductions in major risk factors and the availability of a plethora of effective antihypertensive drugs, the control of blood pressure to target values is still poor due to multiple factors including apparent drug resistance and lack of adherence. An explanation for this problem is related to the current reductionist and 'trial-and-error' approach in the management of hypertension, as we may oversimplify the complex nature of the disease and not pay enough attention to the heterogeneity of the pathophysiology and clinical presentation of the disorder. Taking into account specific risk factors, genetic phenotype, pharmacokinetic characteristics, and other particular features unique to each patient, would allow a personalized approach to managing the disease. Personalized medicine therefore represents the tailoring of medical approach and treatment to the individual characteristics of each patient and is expected to become the paradigm of future healthcare. The advancement of systems biology research and the rapid development of high-throughput technologies, as well as the characterization of different -omics, have contributed to a shift in modern biological and medical research from traditional hypothesis-driven designs toward data-driven studies and have facilitated the evolution of personalized or precision medicine for chronic diseases such as hypertension.
治疗高血压的主要目标是将血压降至生理水平,从而预防心血管疾病风险以及高血压相关的靶器官损害。尽管主要危险因素有所减少,且有大量有效的抗高血压药物可供使用,但由于包括明显的耐药性和依从性差等多种因素,血压控制到目标值的情况仍然不佳。对这一问题的一种解释与当前高血压管理中简化论和“试错”方法有关,因为我们可能过度简化了该疾病的复杂本质,没有充分关注该病症病理生理学和临床表现的异质性。考虑到每个患者特有的特定危险因素、基因表型、药代动力学特征以及其他独特特征,将有助于采取个性化方法来管理该疾病。因此,个性化医疗意味着根据每个患者的个体特征来调整医疗方法和治疗方案,有望成为未来医疗保健的范例。系统生物学研究的进展、高通量技术的快速发展以及不同组学的表征,促使现代生物学和医学研究从传统的假设驱动设计转向数据驱动研究,并推动了针对高血压等慢性疾病的个性化或精准医疗的发展。