Hello, welcome back to the "Hypertension Medical Course." I'm Jessica.
Before this lecture, we talked about the present of hypertension
medicine. In the final lecture of the course, I want to take you to
look at the future of hypertension medicine. Let's see what we can
change and achieve in the face of hypertension in the future, and what
is unimaginable for humans.
When it comes to the future, I know you immediately think—with the
development of medicine, will humans completely conquer hypertension?
Will hypertension disappear completely?
In fact, such questions are too distant, even like science fiction, and
discussing them is not very meaningful. What we need to do is to stand
on the current level of human understanding of hypertension and see
what changes will occur in hypertension medicine in the next two to
three decades.
In 1913, essential hypertension was formally defined for the first
time. In the more than 100 years since then, medical scientists have
done everything possible to measure, diagnose, find the causes and
treatment methods, and connect it with cardiovascular and
cerebrovascular diseases, describing its development process like a
sandbox simulation.
From my current perspective, I believe that in the field of
hypertension, by 2050, three important transformations are very likely.
These transformations will truly affect each of us.
Transformation 1: Early Prediction
For a long time, early detection of hypertension has been a major
problem. Most hypertension has no symptoms, and by the time it is
checked in the hospital, it is found that the hypertension is
irreversible. In the future, can hypertension be detected early?
Reviewing the history of hypertension diagnosis, we find that the
biggest progress in the last decade is the replacement of mercury
sphygmomanometers with electronic sphygmomanometers. Now, almost all
guidelines discuss blood pressure thresholds based on electronic
sphygmomanometers. The reason is simple: whether it is objective error
or subjective error during use, electronic sphygmomanometers are far
smaller than mercury sphygmomanometers. In other words, electronic
sphygmomanometers measure more accurately.
Not only that, the emergence of various new types of sphygmomanometers
has also made large-scale clinical application of 24-hour blood
pressure monitoring possible. In this way, the doctor's understanding
of our blood pressure has expanded from a point in the clinic to a line
in our lives. Therefore, it has also changed the diagnostic criteria
for hypertension to a certain extent, from a single-point diagnosis in
the past to a diagnosis based on the 24-hour average blood pressure.
In recent years, more and more sphygmomanometers have been developed
and put into use. Technologies such as tactile sensing, vascular
unloading technology, pulse transit time, photoplethysmography,
ultrasonic blood pressure measurement, and image processing blood
pressure measurement, these measurement technologies range from
monitoring radial artery blood pressure to perceiving heartbeats, from
wristwatches to mattresses, from implantable to wearable, you can find
everything.
Therefore, in the foreseeable future, our understanding of a person's
blood pressure will be expanded in both length and width.
Length, of course, refers to time. From a single accidental blood
pressure measurement in the past to 24-hour continuous monitoring, and
then to 7 days, 1 month, 1 year, and even from birth to the end of
life, a person's entire blood pressure situation will be completely
recorded and known by the doctor.
Width refers to what we monitor will not only be blood pressure, but
also indicators that are as important as blood pressure but were
previously unobservable, such as vascular stiffness and blood flow
shear stress.
Once we have this data, we can combine it with the current hot big data
technology to obtain a complete data model for hypertension. Throughout
the entire life course, the changes in blood pressure increase will be
very clear.
Correspondingly, based on the big data model and your genes and
lifestyle, perhaps we can predict your future blood pressure trend when
you are in your twenties, and even accurately calculate the specific
time when your hypertension will occur. With this, not only can
hypertension be detected at the first time, but your lifestyle can also
be corrected in time according to the prediction results, thereby
preventing the occurrence of hypertension.
Transformation 2: Personalized Treatment
At present, the treatment plan for hypertension is basically the same.
Tens of thousands or even hundreds of thousands of patients may receive
the exact same drug prescription and lifestyle prescription. But we
know that everyone's body and disease conditions are different. The
same hypertension prescription may be particularly effective for one
person, but completely ineffective for another. This is also the
embarrassment facing medicine today.
In the next thirty years, can we achieve precise treatment for
everyone's hypertension and maximize the treatment effect? The answer
is yes. But the method of realization is not science fiction gene
editing, but the big data just mentioned.
Many people may ask: Isn't gene technology very popular in the past two
years? There have been continuous breakthroughs, why is it not worth
looking forward to?
Indeed. In the past 20 years, some breakthroughs have been made in the
genomics of drug metabolism. In the next 30 years, it is entirely
possible to choose the most suitable drug for you based on your genetic
situation. But that's all. As for the gene editing that many people
expect, just think about it.
Why? There are two main reasons:
First, hypertension does not have a clear definition. As mentioned
earlier, the diagnostic threshold for hypertension is artificially
defined and is constantly changing. It is essentially more like a
non-steady state than a clear disease. Therefore, it is difficult for
precise genomics to match such a broad and loose definition. This is
like using a precise ruler to measure a misty landscape painting, it is
difficult to measure accurately.
Second, hypertension is caused by a variety of factors, and these
factors have cross-effects on each other. Genes affect blood pressure
through many links, such as transcription, translation, modification,
and methylation in the environment. Each link will add N influencing
factors. To fully understand these, not only genomics is needed, but
also RNAomics, proteomics, metabolomics, etc. These breakthroughs
require a lot of time and money.
And the big data technology route is much simpler to implement.
We know that the occurrence and progression of hypertension are closely
related to lifestyle. Therefore, to provide precise and personalized
treatment plans for everyone, two aspects of data are naturally
needed—one is long-term monitoring data of our blood pressure; the
other is our lifestyle data.
The long-term monitoring data of blood pressure has just been
mentioned. More and more advanced blood pressure detection technologies
and equipment can do this task well. And how does the lifestyle data
come from? Various smart devices. For example, the salt you eat can be
accurately obtained by collecting the sodium ion concentration in your
urine through a smart toilet; for example, your exercise situation, we
already have various wearable devices such as pedometers, bracelets,
and heart rate belts; for another example, your tension level can be
formed through data from electrocardiogram, electroencephalogram, and
respiration.
If these two types of data can be monitored in a wide range of people
for decades, then by 2050, we will be able to form a relatively
accurate model system of the impact of lifestyle on blood pressure, and
clarify the proportion of each lifestyle that affects our blood
pressure. Naturally, based on your lifestyle and blood pressure, you
can also be provided with a personalized treatment plan.
In the future, this model will meticulously adjust your life. For
example, if you have salt-sensitive hypertension and your urine sodium
ion exceeds the standard for many consecutive days after entering the
pre-hypertension stage, when you go to the supermarket to buy high-salt
food, a warning will pop up on the payment page of your mobile phone,
hoping that you will reduce high-sodium food. Even your life
information will be synchronized with the insurance company. If you
insist on buying, your premium may increase.
Transformation 3: Changes in Treatment Philosophy
Finally, the third transformation should be in the treatment
philosophy. You may not think about the changes in treatment
philosophy, but in my opinion, this transformation may affect all
aspects of hypertension diagnosis, prevention, and treatment.
In the past, we have always regarded hypertension as a disease. When
blood pressure is high, we lower blood pressure, and when complications
occur, we treat the complications.
However, research in the last decade has increasingly shown us a
picture—hypertension is very likely not an isolated disease, but one
of a group of metabolic diseases.
In addition to hypertension, this group of metabolic disorders also
includes hyperglycemia, hyperlipidemia, and hyperuricemia. They are all
indicators of human metabolism and can all lead to complications such
as stroke, myocardial infarction, renal failure, and heart failure. At
the same time, this group of metabolic diseases also affect each other.
The occurrence of any one of them will greatly increase the probability
of other metabolic disorders. If we adjust our lifestyle from the root
and treat a certain metabolic disorder, it will also greatly reduce the
incidence of other metabolic disorders.
So you see, this group of metabolic diseases is more like one disease.
They have many common causes, produce the same pathological reactions
in the body, and even have common molecular mechanisms, so they will
lead to common diseases.
In the future, if we can figure out the whole picture of this group of
metabolic disorders, clarify their interrelationships, key nodes of
action, and pathogenic mechanisms one by one, our treatment philosophy
for them will undergo a fundamental change—we may no longer lower blood
pressure when blood pressure rises, lower blood lipids when blood
lipids rise, and lower blood sugar when blood sugar rises. Instead, we
will treat them as a large class of comorbidities, dredge them at the
common source, and intercept them on the common key pathways.
Therefore, in addition to this "Hypertension Medical Course," I will
also bring you "Hyperlipidemia Medical Course" and "Hyperglycemia
Medical Course" to help you understand the pathogenesis of this type of
comorbidity and the methods to combat them.
Key Points
In the next two to three decades, hypertension treatment is likely to
see three transformations:
1. Early prediction. Based on big data models and a person's genes and
lifestyle, predict their future blood pressure, and even accurately
calculate the time of their hypertension.
2. Personalized treatment. Based on big data technology, from a
one-size-fits-all prescription to precise and personalized treatment.
3. Change in philosophy. No longer regard hypertension as an isolated
disease, but regard hypertension, hyperlipidemia, hyperglycemia, etc.
as a large class of comorbidities, dredging at the common source and
intercepting on the common key pathways.
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