高血压联盟与转化医学.ppt

高血压联盟与转化医学,刘力生,Purpose of WHL,To develop or promote health by educating and instructing health care professionals and the public on preventative and curative measures for hypertension. 对专业人员和群众进行 健康促进教育 To promote and conduct research related to the prevention and treatment of hypertension 促进和组织防治高血压的研究项目 To promote the detection, control and prevention of hypertension in the population through joint efforts of all national leagues and societies. 联合各国的联盟与学会促进高血压防控工作 To liaise with the national bodies, promoting the exchange of information among them, and offering internationally applicable methods and programs for hypertension control. 与各国家团体联系,交流提供有关控制高血压的国际可行的方法与计划.,转化医学与中国高血压联盟,转化医学是本世纪从循证医学发展而形成的一个医学实践和干预性流行病学的理念，它融汇基础科学、社会科学、政治科学于一体，兼顾治病和预防，其涵盖的领域已超出现行医疗保健服务的范畴。 From bench to bedside to population(实验室临床社区） 转化医学研究可分为： 1期：基础实验研究 2期：基础研究应用于临床: 临床试验,中国高血压指南 3期：改变环境与政策层面的因素才能做到临床公共卫生和预防措施的可持续发展。健康促进与社区防治,Hypertension Clinical Trials 中国临床试验的经验 Liu Lisheng,Chronic Disease in China -2007 CVD Report of China 中国慢病现状,New onset stroke: 2million/yr，Survived stroke:13 million CVD patients: 230 million New onset MI: 0.5 million，survived MI: 3 million；CHD: 8 milllion Patients with chronic diseases in 2003: 574 million ： DM: 33 million- Cancer: 46 million Cerebrovascular diseases: 93 million Cardiac disease: 165 million Hypertension: 237 million,Hypertension Clinical Trials in China,International Trials,International Trials,International Trials,Experience (1/2),Easier to recruit participants from clinics or communities. Concommitant drug treatment are less. large simple trials are feasible in China.,Example:Chinese subjects in HYVET (40% of total sample),Slightly younger, lighter & shorter. Smoked more but drank less alcohol. Less previous episodes of MI, more previous stroke Had lower blood urea, uric acid and Cr , higher HDLC. Blood glucose & TC , Na & K, blood haematocrit & Hb were all lower. Much easier to recruit, less concomitant tr. More compliant to tr. Easier to FU.,Experience (2/2),CHL was established on top of Syst.-China & PATs Collaborative group (31 medical universities) in 1989 & continuing on organizing RCTs both nationally & internationaly Established good relationship with world well known RCT Centers, implicating RCT results in Chinese population successfully. For ex. CCB based tr.used widely in ISH ,captopril in post MI after Syst-China and CCS1 trials.,Translational medicine is a two-way street,Drive to cure should be complemented by going back from bedside to laboratory with observations made in human studies,Pharmacogenetics & individualized medicine,Warfarin dosage in Asian people Can folic acid prevent stroke ? China Stroke Primary Prevention Trial,Warfarin maintenance doses vary among different populations: Asians require lower doses,“Certain single nucleotide polymorphisms in the VKORC1 gene (especially the -1639GA allele) have been associated with lower dose requirements for warfarin”.,Ethnically Different Dose Recommendation,Pharmacogenetics & individualized medicine,Warfarin dosage in RCT (wave study) Can folic acid prevent stroke ? China Stroke Primary Prevention Trial,中国高血压指南,项目设计,开放性、多中心的横断面观察性登记研究，入组已接受降压药物治疗的门诊高血压患者 全国22个城市，100家三甲医院涉及心血管科、肾内科、内分泌科纳入5000例高血压患者 以下问题为本研究关注重点： - 患者的人口学特征 - 患者的血压控制情况 - 患者的心血管危险因素及相关实验室检查结果 - 患者的降压药物应用情况 - 患者的关于高血压治疗的认知状况的调查,Survey of hyperTensive pAtienTs blood pressUre control rate in clinic Service,两大权威机构联合发起并主办,总结,三甲医院心血管科、肾内科、内分泌科门诊高血压患者 血压140/90mmHg达标率为45.1% 糖尿病或肾病患者血压(130/80mmHg)和其他患者 （140/90mmHg）血压达标率为31.1% 最常见的合并疾病依次为血脂异常(43.2%)、糖尿病(37.1%)、冠心病(22.6%)及肾功能不全(18.3%),68.9%,已接受治疗的高血压患者中血压140/90mmHg不断提高！,2006年中国心血管病报告,0%,20%,40%,60%,80%,100%,87.3%,80.1%,75%,54.9%,12.7%,19.9%,25.0%,87.3%,80.1%,75%,54.9%,12.7%,19.9%,25.0%,45.1%,68.9%,31.1%,31.1%,45.1%,CHINA STATUS 数据,引发的思考,但我们仍然面临挑战 31.1%的达标率对我们是否已经足够好? 多数高血压患者合并其他疾病，降压需要更关注器官的保护 60%的患者从不漏服降压药物，而总体达标率31.1%，( 140/90mmHg为45.1%)提示我们是否应该选择更强更有效的治疗方案，以使血压尽早达标。,我们仍要为提高我国高血压患者的知晓率，治疗率和达标率、继续努力！,继续教育与宣传群众,可持续发展的社区防治,Epidemiological report from China DATA FROM 5- AND 10 YEAR FOLLOW-UP SURVEYS OF 10,450 WORKERS 本文刊登于Mild Hy