中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋課件

1、中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋20042004年中國(guó)高血壓防治指南年中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋重點(diǎn)內(nèi)容解釋中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋重點(diǎn)內(nèi)容重點(diǎn)內(nèi)容q血壓分類和定義q心血管危險(xiǎn)分層q血壓控制目標(biāo)值q聯(lián)合治療方案中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋血壓水平的分類和定義血壓水平的分類和定義 分類 收縮壓(mmHg) 舒張壓(mmHg)正常血壓 120 和 80正常高值 120-139 或 80-89高血壓 140 或 90 1級(jí) 140-159 或 90-99 2級(jí) 160-179 或 100-109 3級(jí) 180 或 110單純收縮期高血壓 140 和 55歲q女性65歲q吸煙q血脂異常: T

2、C5.7mmol/L(220mg/dl) 或LDL-C3.3mmol/L(130mg/dl) 或HDL-C1.0mmol/L(40mg/dl)q早發(fā)心血管病家族史(一級(jí)親屬發(fā)病年齡38mv, Cornel2440mmmms 超聲心動(dòng)圖LVMI或X線q頸動(dòng)脈超聲IMT0.9mm或動(dòng)脈粥樣斑塊q血請(qǐng)肌酐輕度升高 男性 115-133mol/L或1.3-1.5mg/dl 女性 107-124mol/L或1.2-1.4mg/dlq微量白蛋白尿 30-300mg/24h 白蛋白/肌酐:男性22mg/g(2.5mg/mmol) 女性31mg/g(3.5mg/mmol)中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋Manc

3、ia G. et al., J Hypertens 2004; 22:51-57454035302520151050None1234Additional risk factors13.7%39.8%32.4%12.1%2.0%高血壓常與其它心血管危險(xiǎn)因素合并存在高血壓常與其它心血管危險(xiǎn)因素合并存在%中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋Microalbuminuria6543210Relative risk of IHDSBP 160Normoalbuminuria2.5 (1.2-5.3)5.3 (2.2-13.0)3.3 (1.6-6.9)2.2 (1.3-3.7)1.01.5 (0.9-2.7)

4、收縮壓、微量蛋白尿與心血管危險(xiǎn)收縮壓、微量蛋白尿與心血管危險(xiǎn)Borch-Johnsen K, et al. Arteioscler Thromb Vasc Biol 1999; 19:1992中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋Risk factor CV/1000 pt.yRRCl(95%)YesNoGender(M vs F)12.0 7.21.62(1.421.94)Age(65 vs 65 yrs)15.0 7.32.06(1.772.39)Smoking 14.0 8.91.57(1.311.88)S-Cholesterol(6.8 vs 6.8 mmol/l) 11.69.01.29(1

5、.091.53) S-Creatinine(1.3 vs 1.3 mg/dl) 21.8 8.72.50(2.033.07) Diabetes 18.3 9.02.03(1.652.51) Ischemic Heart Disease 18.4 8.12.27(1.932.68) 中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋HOTHOT：心血管危險(xiǎn)分層與：心血管危險(xiǎn)分層與CVDCVD事件事件BMJ 2002, 324:71RR： 1.58 1.38 1.60 1.79 1.51Cl: 1.45-1.72 1.18-1.61 1.41-1.82 1.56-2.05 1.38-1.66P:0.0001 0.00

6、01 0.0001 0.0001 0.0001MajorcardiovasculareventsAll myocardialinfarctionAll strokeCardiovascularmortalityTotalmortalityRisk:MediumHighVery High20151050Events per 1000 patient years中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋Risk Reclassification in APROS StudyCuspidi et al., J Hypertens 2002; 20:1307-1315100806040200%InitialFin

7、al *HighMediumLowRisk:* After ecocardiogram +carotid ultrasonography81.3%18.7%53.2%35.7%11.1%中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋血壓控制目標(biāo)值血壓控制目標(biāo)值q中青年高血壓患者 140/90 mmHgq老年高血壓患者 150/90 mmHg q糖尿病或腎病患者130/80 mmHg中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋0.51.02.0Relative RiskBP-Lowering Treatment TrialistsComparisons of Different Active Treatments中國(guó)高血壓防

8、治指南重點(diǎn)內(nèi)容解釋Fatal/Non-fatal cardiac eventsFatal/Non-fatal strokeAll-cause deathMyocardial infarctionHeart failure hospitalisations0.40.60.81.01.21.4Controlled patients*(n = 10755)Non-controlled patients(n = 4490)Hazard Ratio 95% CI*SBP 140 mmHg at 6 months.Pooled Treatment Groups*P 0.01.0.75 (0.670.83)

9、0.55 (0.460.64)0.79 (0.710.88)0.86 (0.731.01)0.64 (0.550.74)Odds RatioWeber MA et al. Lancet. 2004;363:204749.VALUE:根據(jù)根據(jù)6個(gè)月時(shí)血壓控制情況的結(jié)果分析個(gè)月時(shí)血壓控制情況的結(jié)果分析中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋CVD Survival in Treated Hypertensives at Goal and Not at Goal中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋1210864208090100110120130Diastolic blood pres

10、sure (mm Hg)CV eventsElderlypatients Patients With Diabetes and other CV riskFactors HypertensivesWith average risk Hypertensives With lower thanaverage riskRelationship between diastolic (in principle, similar for systolic) blood pressures and cardiovascular (CV) events (arbitray scale) in hyperten

11、sive patients with different levels of cardiovascular risk中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋Major cardiovascular events (per 100 patients-years) in all treated hypertensive and in hypertensive patients with diabetes in relation to target blood pressures of 90. 85, and 80 mm Hg. 302520151050 80 85 90 90 85 80P=0.50 for

12、 trendP=0.005 for trendAll hypertensive patients(n=18790)Hypertensive with diabetes(n=1501)Target blood pressure groupsMajor cardiovascular events/1000 patients-yearsHOT: HOT: 糖尿病與非糖尿病患者的糖尿病與非糖尿病患者的CVCV事件發(fā)生率事件發(fā)生率中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋老年高血壓患者血壓控制目標(biāo)值調(diào)整的原因老年高血壓患者血壓控制目標(biāo)值調(diào)整的原因q老年ISH臨床試驗(yàn)(SHEP, SYST-EURO, SYST-CHINA) SBP目標(biāo)： 150 mmHgq大多數(shù)降壓治療臨床試驗(yàn)結(jié)果： SBP目標(biāo) 140 mmHg 較難達(dá)到中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋q利尿劑b-阻滯劑-阻滯劑 鈣拮抗劑ACE抑制劑血管緊張素II受體拮抗劑q固定劑量復(fù)方降壓制劑中國(guó)高血壓防治指南重點(diǎn)內(nèi)容解釋推薦的降壓聯(lián)合治療方案推薦的降壓聯(lián)合