中國高血壓防治指南重點內(nèi)容解釋課件

1、中國高血壓防治指南重點內(nèi)容解釋課件中國高血壓防治指南重點內(nèi)容解釋課件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 140-159 或 90-99 2級 160-179 或 100-109 3級 180 或 110單純收縮期高血壓 140 和 90血壓水平的分類和定義 分類 收縮壓(Systolic Blood Pressure 150 mmHg160 mmHg140 mmHg130 mmHg120 mmHg100806040200020406080100False-positi

2、ve error rate (%)SensitivityPater C. Current Controlled Trials in Cardiovascular Medicine. 2019,6 : 5Systolic Blood Pressure150 mmHVasan et al. N Engl J Med. 2019;345:1291-1297.High-Normal BP and CVD RiskFramingham StudyWomen1086420Time (years)02468101214P.001MenCumulative Incidence (%i

3、me (years)02468101214P.001High normal 130-139/85-89 mm Hg Normal 120-129/80-84 mm Hg Optimal 55歲女性65歲吸煙血脂異常: TC5.7mmol/L(220mg/dl) 或LDL-C3.3mmol/L(130mg/dl) 或HDL-C1.0mmol/L(40mg/dl)早發(fā)心血管病家族史(一級親屬發(fā)病年齡38mv, Cornel2440mmmms 超聲心動圖LVMI或X線頸動脈超聲IMT0.9mm或動脈粥樣斑塊血請肌酐輕度升高 男性 115-133mol/L或1.3-1.5mg/dl 女性 107-12

4、4mol/L或1.2-1.4mg/dl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)靶器官損害左心室肥厚Mancia G. et al., J Hypertens 2019; 22:51-57454035302520151050None1234Additional risk factors13.7%39.8%32.4%12.1%2.0%5221518123546176高血壓常與其它心血管危險因素合并存在%Mancia G. et al., J Hypertens Microalbuminuria65432

5、10Relative 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)收縮壓、微量蛋白尿與心血管危險Borch-Johnsen K, et al. Arteioscler Thromb Vasc Biol 2019; 19:1992Microalbuminuria6543210RelativHOT 心血管危險因素研究血壓水平以外的各項因素對CVD發(fā)生率的影響Risk factor CV/1000 pt.yRRCl(95%)YesNoGen

6、der(M vs F)12.07.21.62(1.421.94)Age(65 vs 65 yrs)15.07.32.06(1.772.39)Smoking 14.08.91.57(1.311.88)S-Cholesterol(6.8 vs 6.8 mmol/l) 11.69.01.29(1.091.53) S-Creatinine(1.3 vs 1.3 mg/dl) 21.88.72.50(2.033.07) Diabetes 18.39.02.03(1.652.51) Ischemic Heart Disease 18.48.12.27(1.932.68) HOT 心血管危險因素研究Risk

7、 factor HOT：心血管危險分層與CVD事件BMJ 2019, 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 0.0001 0.0001 0.0001 0.0001MajorcardiovasculareventsAll myocardialinfarctionAll strokeCardiovascularmortalityTotalmortalityRisk:MediumHighVery High20151050Events per 1000

8、patient yearsHOT：心血管危險分層與CVD事件BMJ 2019, 324Risk Reclassification in APROS StudyCuspidi et al., J Hypertens 2019; 20:1307-1315100806040200%InitialFinal *HighMediumLowRisk:*After ecocardiogram +carotid ultrasonography81.3%18.7%53.2%35.7%11.1%Risk Reclassification in APROS血壓控制目標(biāo)值中青年高血壓患者 140/90 mmHg老年高

9、血壓患者 150/90 mmHg 糖尿病或腎病患者130/80 mmHg血壓控制目標(biāo)值中青年高血壓患者 140/90 mmH0.51.02.0Relative Risk RR (95% CI)BP Difference(mm Hg)FavorsFirst ListedFavorsSecond ListedMajor CV eventsCV mortalityTotal mortality 1.02 (0.98, 1.07)2/0 ACEI vs D/BB 1.03 (0.95, 1.11)2/0 ACEI vs D/BB 1.00 (0.95, 1.05)2/0 ACEI vs D/BB 1.

10、04 (0.99, 1.08)1/0 CA vs D/BB 1.05 (0.97, 1.13)1/0 CA vs D/BB 0.99 (0.95, 1.04)1/0 CA vs D/BB 0.97 (0.92, 1.03)1/1 ACEI vs CA 1.03 (0.94, 1.13)1/1 ACEI vs CA 1.04 (0.98, 1.10)1/1 ACEI vs CABlood Pressure Lowering Treatment Trialists Collaboration. Lancet. 2019;362:1527-1535.BP-Lowering Treatment Tri

11、alistsComparisons of Different Active Treatments0.51.02.0Relative Risk RR (95%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*SB

12、P 140 mmHg at 6 months.Pooled Treatment Groups*P 0.01.0.75 (0.670.83)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. 2019;363:204749.VALUE:根據(jù)6個月時血壓控制情況的結(jié)果分析Fatal/Non-fatal cardiac events中國高血壓防治指南重點內(nèi)容解釋課件Benetos et al. J Hypertens. 2019;21:1635-1640.Follo

13、w-up (Years)Survival (%)10.960.920.880.840.8135791113151719212325P=.03P.0001P=.001Treated BP not at goal 140/90 mm Hg Untreated BP 140/90 mm Hg Untreated BP 140/90 mm HgTreated BP at goal 140/90 mm HgCVD Survival in Treated Hypertensives at Goal and Not at GoalBenetos et al. J Hypertens. 20121086420

14、8090100110120130Diastolic blood pressure (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)

15、 events (arbitray scale) in hypertensive patients with different levels of cardiovascular risk1210864208090100110120130DiastMajor 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

16、 80 mm Hg. 302520151050 80 85 90 90 85 80P=0.50 for trendP=0.005 for trendAll hypertensive patients(n=18790)Hypertensive with diabetes(n=1501)Target blood pressure groupsMajor cardiovascular events/1000 patients-yearsHOT: 糖尿病與非糖尿病患者的CV事件發(fā)生率Major cardiovascular events (p老年高血壓患者血壓控制目標(biāo)值調(diào)整的原因老年ISH臨床試驗(SHEP, SYST-EURO, SYST-CHINA) SBP目標(biāo)： 150 mmHg大多數(shù)降壓治療臨床試驗結(jié)果： SBP目標(biāo) 140 mmHg 較難達到老年高血壓患者血壓控制目標(biāo)值調(diào)整的原因老年ISH臨床試驗(S常用降壓藥物利尿劑b-阻滯劑-阻滯劑 鈣拮抗劑ACE抑制劑血管緊張素II受體拮抗劑固定劑量復(fù)方降壓制劑常用降壓藥物