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A call to action and a life-course strategy to address the global burden of raised blood pressure on current and future generations. The Lancet Commission on Hypertension 

Despite extensive knowledge regarding prevention and treatment of hypertension, the global incidence and prevalence of hypertension and, more importantly, its cardiovascular complications are not reduced – in part due to inadequacies in prevention, diagnosis and control of the disorder in an ageing world.  

The Lancet through the International Society of Hypertension in Seoul, in September 2016 took the first step reviewing the current evidence for the prevention, identification and treatment of high BP, hypertension and its cardiovascular complications. 

 The report is built around the concept of lifetime risk, applicable to the entire population from conception. Development of subclinical and sometimes, clinical, cardiovascular disease results from the lifetime exposure to cardiovascular risk factors combined with individual susceptibility to the harmful consequences of these risk factors.  

The Hypertension commission focuses primarily on issues and actions related to high BP. 

Figure 3: Early-life effects and impact of preventive efforts in the management of elevated blood pressure    

The main goal of preventive efforts (small grey arrows) is to shift an individual’s lifecourse towards the ideal lifecourse. Depending upon genetic disposition and/or epigenetic imprinting during foetal life, individuals can start their life-course higher or lower on the health-disease continuum (the enlarged insert), reflecting the so-called cohort effect. The orange dashed lines show the impact of a preventive effort, with a resultant downward shift in the life-course curve. Early preventive efforts are likely to result in a substantial gain in time (x-axis) or disease progression (y-axis) compared to later preventive efforts. 

The Lancet Commission on hypertension, 2016 Sep 22,  with permission from Elsevier. Available at doi:10.1016/S0140-6736(16)31134-5. 

Fuente: JAMA, 25/03/2022

Revista: JAMA Netw Open. 2022;5³:e223849. doi:10.1001/jamanetworkopen.2022.3849

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