高血压英文ppt精品课件hypertension cardiovascular risk

Hypertension 50:272-98 Approximate mean usual BP Approximate mean usual BP 123 76 123 76 136 84 136 84 148 91 148 91 162 98 162 98 175 105 175 105 4.00 2.00 1.00 0.50 0.25 4.00 2.00 1.00 0.50 0.25 Stroke CHD Blood Pressure and Risk of Congestive Heart Failure: the Framingham Study Average annual rate/ 10,000 Age at examination Normotensive BP 160/95 mmHg Kannel et al. 1972 Systolic BP as a risk factor for renal failure Systolic BP, mmHg Incidence / 100,000 person years MRFIT screenees Klag MJ, JAMA 97; 277: 1293 Cholesterol and risk of CHD 50:272-98 Total number of individuals affected Stroke CHD All vascular deaths All other deaths 1200 1000 800 600 400 200 % reduction in odds 38% SD 4 16% SD 4 T C T C T C T C Fatal events Non-fatal events T=treatment C=control The ideal antihypertensive ? l No contraindications l Inexpensive l Effective as monotherapy l Simple once daily dosage l Prevents / reverses target organ damage l Improves mortality / morbidity l No side-effects or adverse metabolic effects l Combinable with other drugs l Genetically targeted Drug treatment of hypertension Diuretic Beta-blocker Calcium-channel blocker ACE-inhibitor (Alpha-blocker) Angiotensin receptor blocker l Most hypertensives will need 2 drugs to control BP l Drug combinations may be synergistic How to choose anti-hypertensive therapy ACE inhibitor (AII antagonist) A or -blocker B Calcium antagonist C Diuretic D One drug: Younger, non-black A or B Older, black C or D Two drugs: (A or B) + (C or D) Three drugs: (A or B) + C + D Target blood pressure 140/90 mmHg . except in those with diabetes or chronic renal disease 130/80 mmHg % of hypertensives with controlled BP USA1 27% England2 6% 140/90 mm Hg Canada3 16% Australia4 19% Zaire4 2.5% India4 9% Scotland4 17.5% Spain4 20% Finland4 20.5% 160/95 mm Hg Adapted from Mancia, 1997 Cholesterol 143(suppl 1):S17-S21. Percentage with CHD event LDL-C, mmol/L (mg/dL) S=statin treated; P=placebo treated * Extrapolated to 5 Years Secondary prevention Primary prevention Simvastatin Pravastatin Lovastatin ASCOT-S* ASCOT-P* AtorvastatinHPSl-S HPSh-S HPSl-P HPSh-P Xanthelasma & corneal arcus Tendon xanthomata Heart Protection Study: Effect of simvastatin on major vascular events 0 1 2 3 4 5 6 0 5 10 15 20 25 30 Years of follow-up 5(3) 20(4) 35(5) SIMVASTATIN PLACEBO 46(5) 54(7) 60(18)Benefit/1000 (SE): People suffering events (%) 36% reduction HR = 0.64 (0.50-0.83) Atorvastatin 10 mg Number of events 100 Placebo Number of events 154 p=0.0005 ASCOT study: Effect of atorvastatin on CHD ASCOT study: Effect of atorvastatin on stroke 27% reduction HR = 0.73 (0.56-0.96) p=0.0236 Atorvastatin 10 mg Number of events 89 Placebo Number of