Department of Renal Medicine, Royal Infirmary of Edinburgh & University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, UK.
Br J Clin Pharmacol. 2021 Oct;87(10):3721-3736. doi: 10.1111/bcp.14825. Epub 2021 May 3.
Hypertension is a significant and increasing global health issue. It is a leading cause of cardiovascular disease and premature death worldwide due to its effects on end organs, and through its associations with chronic kidney disease, diabetes mellitus and obesity. Despite current management strategies, many patients do not achieve adequate blood pressure (BP) control. Hypertension-related cardiovascular mortality rates are rising in tandem with the increasing global prevalence of chronic kidney disease, diabetes mellitus and obesity. Improving BP control must therefore be urgently prioritised. Strategies include utilising existing antihypertensive agents more effectively, and using treatments developed for co-existing conditions (such as sodium-glucose cotransporter 2 inhibitors for diabetes mellitus) that offer additional BP-lowering and cardiovascular benefits. Additionally, novel therapeutic agents that target alternative prohypertensive pathways and that offer broader cardiovascular protection are under development, including dual angiotensin receptor-neprilysin inhibitors. Nonpharmacological strategies such as immunotherapy are also being explored. Finally, advancing knowledge of the human genome and molecular modification technology may usher in an exciting new era of personalised medicine, with the potential to revolutionise the management of hypertension.
高血压是一个重大且日益严重的全球健康问题。由于其对终末器官的影响，以及与慢性肾脏病、糖尿病和肥胖的关联，高血压是全世界导致心血管疾病和过早死亡的主要原因。尽管目前有管理策略，但许多患者的血压（BP）控制仍不理想。与慢性肾脏病、糖尿病和肥胖的全球患病率不断增加相一致，高血压相关的心血管死亡率也在上升。因此，必须紧急优先考虑改善血压控制。策略包括更有效地利用现有的抗高血压药物，并使用针对共存疾病（如钠-葡萄糖共转运蛋白 2 抑制剂治疗糖尿病）开发的治疗方法，这些治疗方法除了降低血压外，还有心血管益处。此外，还在开发针对其他高血压途径的新型治疗药物，并提供更广泛的心血管保护，包括双重血管紧张素受体-脑啡肽酶抑制剂。正在探索免疫疗法等非药物策略。最后，人类基因组和分子修饰技术知识的进步可能开创个性化医疗的激动人心的新时代，有可能彻底改变高血压的管理。
