高血压英文ppt精品课件general medicine

General Medicine Update Minnesota ACP November, 2010 Steve Hillson General Internal Medicine Hennepin County Medical Center University of Minnesota s_ Objectives At the end of this session you should be able to: Describe the main results of several important reports from the past year Decide how you want to change your practice in the context of these findings Disclosure I have no direct financial relationships with any commercial firm having any interest in any of the reports or topics I am about to discuss. Process Personally reviewed title of every original research article from 10/08/09 till 10/15/10 in: Annals of Internal Medicine BMJ JAMA Lancet New England Journal of Medicine American Journal of Medicine Reviewed subspecialty updates, scattered other sources Personally reviewed abstract of every article with “interesting” title. Process (contd) Selected “promising” articles by initial abstract review (about 100) Re-reviewed all abstracts, selecting about 50 with medium or high impact potential Solicited abstract reviews from colleagues to select subset of greatest importance Critically appraised final subset for presentation Limitations on Process Personal idiosyncrasies Incomplete survey of medical literature No claim to comprehensive context for assessing these articles Very simplified presentation of complex research Blood Pressure How aggressive should we be for high-risk patients? 3 Important Articles Effects of intensive blood-pressure control in type 2 diabetes mellitus (ACCORD), NEJM, April 2010 Funded by the NIH, medicines contributed by various pharmaceutical companies Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease, JAMA, July 2010 Funded by a pharmaceutical company Intensive blood-pressure control in hypertensive chronic kidney disease, NEJM, September 2010 Funded by NIH and pharmaceutical companies Purpose Assess whether cardiovascular outcomes can be improved by aggressive blood pressure control Previous information Cardiovascular risk rises throughout the range of systolic BPs JNC 7 recommends medical treatment of SBP to below 130 Some recommendations for even tighter control in especially high risk circumstances, particularly with chronic kidney disease #1 ACCORD substudy Compare tighter (SBP 80, on anticoagulation or aspirin Used B-blockers, Ca-blockers, Dig to achieve Strict control (P 74 AGAINST BSE NO RECOMMENDATION for CBE NO RECOMMENDATION for digital mammography or MRI Limitations Does not address higher-risk women or men Remains contentious An SGIM workshop was about equally divided on the age 40-49 recommendation Implications The value of breast cancer screening is getting better defined Harms are more clear Benefits in some groups are small Treatment of non-screen-detected breast cancer is improving The issue is problematic Differing views of other prominent organizations ACS recommends annual mammogram starting at 40, CBE starting at 20, and optional BSE Women (and