Precision medicine, when applied to prevention, can identify opportunities for an individual to reduce their cardiovascular risk. Resulting interventions are personalized and may take advantage of the latest science, including genetics. Such interventions may presuppose that basic risk factors – such as hypertension and diabetes – have been identified and maximally controlled. Intervening upon more recently identified risk factors may have less or no impact if dominant risk factors such as hypertension are not adequately controlled.
In contrast, population health interventions could indiscriminately improve health for individuals by targeting well-accepted, high-stakes risk factors. For example, although hypertension is accepted as the leading risk factor for cardiovascular disease, we see patients every day with poorly controlled blood pressure in the clinic and hospital. Controlling such risk factors could raise the bar more uniformly so that more people may benefit from the additional gains of precision prevention.
Engaging patients in their own health care may be an effective strategy. For example, in the recently published TASMINH4 trial from the United Kingdom, patients empowered to monitor their blood pressure at home and present the data to their doctors had improved blood pressure control, as compared to individuals receiving routine care.1
While such research can be frustratingly complex to perform and interpret, the benefits of standardizing and incorporating sound methods for improving blood pressure control cannot be understated. Translating this into clinical practice may require a new information infrastructure and possibly changes to reimbursement schemes, due to the possible added burden of reviewing additional data.
In this era of enthusiasm for precision medicine, we should continue to pursue population health and implementation science with equal gusto, especially in countries with high health care disparities such as the United States.
- McManus RJ, Mant J, Franssen M, Nickless A, Schwartz C, Hodgkinson J, et al. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomized controlled trial. Lancet. 2018. https://doi.org/10.1016/S0140-6736(18)30309-X
Neal S. Parikh, MD, earned his MD from Weill Cornell Medical College and completed residency training in neurology at the same institution. He is now an NIH T32 neuro-epidemiology and vascular neurology fellow at New York-Presbyterian Hospital/Columbia University Medical Center. He tweets @NealSParikhMD and contributes to Blogging Stroke as a blogger.