Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Hypertens Res. 2019 Mar;42(3):301-305. doi: 10.1038/s41440-018-0177-3. Epub 2018 Dec 18.
Pre-emptive medicine is a novel medical concept proposed in Japan that aims to precisely predict the onset and progression of diseases and to provide therapeutic interventions during early stages, before symptoms appear. The concept of pre-emptive medicine considers the time-course of a disease in each individual and seeks medical interventions to prevent disease progression. Suitable and promising targets for pre-emptive medicine are non-communicable diseases, including hypertension. Recent advances in genomic analysis, information technology, and artificial intelligence should make this medical concept feasible in the near future. In this review, we focused on pre-emptive medicine for hypertension, referring to concrete plans for the future direction of this research. The ultimate goal of pre-emptive medicine is to completely prevent the onset and progression of hypertension by precisely predicting the elevation of blood pressure and performing interventions to avoid it. The diagnostic processes of hypertension, from the standpoint of pre-emptive medicine, should include the detection of abnormal blood pressure regulation as the earliest manifestation of the disease, the depiction of the present status of hypertension in an individual ("nowcasting"), and a prediction of the future trajectory of the disease ("forecasting"). Novel therapeutic strategies for hypertension, from the standpoint of pre-emptive medicine, should aim for the regression of hypertension through early treatments and the remission of hypertension through intermittent intensive therapies. An efficient modification of lifestyle and therapies, according to the progression of hypertension, should be required. If pre-emptive medicine for hypertension becomes established, it would greatly contribute to the extension of a healthy lifespan, which cannot yet be satisfactorily achieved.
日本提出了一种新颖的医学概念——预防性医学，旨在精准预测疾病的发生和进展，并在症状出现前的早期阶段提供治疗干预。预防性医学的概念考虑了个体疾病的时间进程，并寻求医疗干预措施来阻止疾病进展。适合且有前景的预防性医学的目标是非传染性疾病，包括高血压。基因组分析、信息技术和人工智能的最新进展应该使这一医学概念在不久的将来成为可能。在这篇综述中，我们重点关注了高血压的预防性医学，并提到了这一研究未来方向的具体计划。预防性医学的最终目标是通过精准预测血压升高并进行干预来完全预防高血压的发生和进展。从预防性医学的角度来看，高血压的诊断过程应该包括检测血压调节异常作为疾病的最早表现，描绘个体中高血压的现状（“实时预测”），以及预测疾病的未来轨迹（“预测”）。从预防性医学的角度来看，高血压的新型治疗策略应该旨在通过早期治疗使高血压消退，并通过间歇性强化治疗使高血压缓解。根据高血压的进展，应该需要对生活方式和治疗进行有效的调整。如果高血压的预防性医学得到确立，将极大地有助于延长健康寿命，而这一目标目前还无法令人满意地实现。
