高血压知识讲座.ppt

高血压指南看 高血压治疗趋势及进展 （从指南到实践） 60 50 40 30 20 10 0 NorthSouth Prevalence (%) 50.2 31.5 7.9 10.7 33.2 46.5 Aware Treatred Controlled 中国人群高血压患病、知晓、治疗和控制率 Reynolds K, et al. J Hypertens 2003;21:1273 高血压 患病率 患病人数 18.8% 1.6亿 2005年中国高血压指南 修订： 1、高血压分类修改 2、危险分层中的条件修改 3、治疗中强调：联合治疗、血压控制 平稳的重要及血压达标的重要。 Event reduction in patients onEvent reduction in patients on active antihypertensive treatment active antihypertensive treatment StrokeStrokeCHDCHD AllAll causecauseCVCV NonNon CVCV Fatal and Fatal and non-fatal eventsnon-fatal events MortalityMortality Systolic-diastolic hypertensionSystolic-diastolic hypertension StrokeStrokeCHDCHD AllAll causecauseCVCV NonNon CVCV Fatal and Fatal and non-fatal eventsnon-fatal events MortalityMortality Isolated systolic hypertensionIsolated systolic hypertension 50% 2003 JNC 7 2005中国血压的分类（6分法） 类别 收缩压（mmHg) 舒张压（mmHg) 正常血压 140 90 1级高血压（轻） 140-159 90-99 2级高血压（中） 160-179 100-109 3级高血压（重） 180 110 单纯收缩期高血压 140 20% 4、反杓型血压 夜间血压高于 白天血压 5% Greater BP Reductions Observed in Monotherapy with Irbesartan 150mg or Valsartan 80mg* BP / Baseline (mm Hg) irbesartan 150 mgvalsartan 80 mg Self Measurement (Morning values) ABPMOffice Measurement (Trough) ADBPASBP (P 160/90 mmHg, at investigators discretionif BP 160/90 mmHg, at investigators discretion 1351 Z1351 Z 全程下降4mmHg SBP SBP (mmHg)(mmHg) 随访随访( (月月) ) 142.5142.5 137.3137.3 141.6141.6 138.1138.1 S S R R -606121824303642485460 120 130 140 150 160 170 DBP DBP 随访随访 ( (月月) ) 85.085.0 82.582.5 83.983.9 82.382.3 S S R R -60612 18 24303642485460 75 80 85 90 95 100 中风中风 致死性致死性 非致死性非致死性 全部心血管事件全部心血管事件 全部心脏事件全部心脏事件 全因死亡全因死亡 心血管死亡心血管死亡 冠脉事件冠脉事件 心衰心衰 新发糖尿病新发糖尿病 癌症癌症 FelodipineFelodipine 11.211.2 2.1 2.1 9.1 9.1 15.215.2 4.6 4.6 7.1 7.1 4.6 4.6 4.5 4.5 1.1 1.1 3.6 3.6 2.6 2.6 PlaceboPlacebo 15.915.9 3.1 3.1 12.712.7 21.221.2 6.6 6.6 9.6 9.6 6.4 6.4 6.2 6.2 1.7 1.7 3.5 3.5 3.9 3.9 风险比风险比 (95% CI)(95% CI)每每 1000 1000 例例- -年年 0.40.40.60.60.80.81.01.01.51.52.02.0 FelodipineFelodipine更好更好PlaceboPlacebo更好更好 0.720.72 0.70 0.70 0.72 0.72 0.72 0.72 0.66 0.66 0.70 0.70 0.68 0.68 0.68 0.68 0.76 0.76 1.03 1.03 0.60 0.60 SBP 下降4.6mmHg DBP 下降2.5mmHg FEVER 研究 CCB+利尿剂 vs 利尿剂 全程下降 2 mmHg 氨氯地平 5-10 mg阿替洛尔 50-100 mg 培哚普利 4-8 mg 苄氟噻嗪 1.25-2.5 mg 多沙唑嗪 GITS 4-8 mg add add add 其他可添加药物, 如, moxonidine/spironolactone add 治疗方案的血压目标值 135/85 mmHg 正常血压 诊室血压 140/90 mmHg 动态血压 135/85 mmHg 白大衣高血压 诊室血压 140 /90 mmHg 动态血压 7.3 MI or stroke Any cardiovascular event Elevated CRP, an inflammatory marker, predicts cardiovascular disease * * n = 366 *P = 0.001 compared with CRP 55yr) orOlder (55yr) or Black at any Age Black at any Age Step 1Step 1 A A C or DC or D Management of Hypertension: Management of Hypertension: NICE Draft Guidelines February NICE Draft Guidelines February 20062006 Step 2Step 2 + + A A C or DC or D Step 3Step 3 + + + + A A C C D D Step 4 Step 4 Resistant HTResistant HT Add: either Add: either - blocker or - blocker or - blocker - blocker or spironolactone or other diureticor spironolactone or other diuretic In hypertensive patients aged 55 or over, or Black patients of any age, first-choice initial therapy should be a dihydropyridine calcium channel blocker; a thiazide- type diuretic is an alternative. ASCOT：收缩压和舒张压 mm Hg 60 80 100 120 140 160 180 Time (years) Baseline0.511.522.533.544.555.5 阿替洛尔 苄氟噻嗪 氨氯地平 培哚普利 137.7 136.1 79.2 77.4 Mean difference 1.9 Last visit Mean difference 2.7 SBP DBP 163.9 164.1 94.8 94.5 ASCOT：收缩压和舒张压 mm Hg 60 80 100 120 140 160 180 Time (years) Baseline0.511.522.533.544.555.5 阿替洛尔 苄氟噻嗪 氨氯地平 培哚普利 137.7 136.1 79.2 77.4 Mean difference 1.9 Last visit Mean difference 2.7 SBP DBP 163.9 164.1 94.8 94.5 前个月SBP下 降.2 mmHg 前个月DBP下降 2.4 mmHg 病例总结 1、血压判断不能仅根据诊室血压，要参考 动态 血压及家测血压 2