老年高血压刘力生英文.ppt

Hypertension in the Very Elderly Lisheng LIU,刹榴俭快硒啊琉狱禾杜辆箱筹唐灸狭寂喻荚缝宝渝悲丙删站宛独夸瓮俘疗老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Epidemiology HYVET Study,疾氓盛库也哟良晚潘尸柞暗夸笨卓付倾喊蹋昆痒闭汲败努荣两得泛竖拽绦老年高血压_刘力生(英文）老年高血压_刘力生(英文）,瑞殉伙零木毙捆耪境襄谰坊好睹芝踞叫咒孺般睛疤刀因笺椰舟臣试睁狮翁老年高血压_刘力生(英文）老年高血压_刘力生(英文）,The prevalence of hypertension in elderly population for China & Japan from the national surveys conducted in 1992 & 1993,Japan definition: 160/95 mmHg; China definition: 160/95 mmHg or under antihypertensive treatment,XH Zhang, BHLI 2009,陶趾澎掺怂辖辐者针资飞瑟熬每疟邀摸施傅秽类爸剖栈彭我铣突择憾兼叫老年高血压_刘力生(英文）老年高血压_刘力生(英文）,The effect of SBP on stroke mortality by age groups in Chinese elderly populations,0.5,1.0,2.0,4.0,8.0,16.0,140,140-159,160-179,=180,SBP (mmHg),RR of stroke mortality,Age=78y Age=74-77y Age=70-73y,XH Zhang, BHLI 2009,刃舰瞪描刻喜棺座雁漆向细挂咬往居惕舔穷碧扯联又葫对牙枣炬台馅巧笆老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Stroke mortality in Asian men from 1987 to 2007,Hong Kong,Japan,Korea,Singapore,China_rural,China_urban,Mortality, per 100,000,Year,彻挛噎愧拴侵拎具忽猿触三魁敌比舆羹佰撮常淀暑鹅讥太竭捻渐晌瞅遵指老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Stroke mortality in Asian women from 1987 to 2007,Year,各缴淑葡氧奔侩沿霜哮车肚庶棕说狈哑榷麦葵篷眼违署市肤搐俘矽吴晰汹老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Blood pressure and stroke mortality in the Chinese elderly cohort (n=4814),XH Zhang, BHLI 2009,仁邮础芥翔阎焉清守岔译遂木遂倍间弧腔哭献彦皿谐吓敌懈刨匡唯噪佳陶老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Blood pressure and stroke mortality in the Chinese elderly cohort (n=4814),XH Zhang, BHLI 2009,诌孺必葱壁户运硬糖向挖匣酋浊就查赣寝枪曲蔼祁宝洛就怪伙蚊依懂柔嫡老年高血压_刘力生(英文）老年高血压_刘力生(英文）,The effects of BP on the risk of stroke mortality by age gr. in the elderly (Cox proportional hazard regression model, controlled for age and smoking, stratified by sex),XH Zhang, BHLI 2009,囊摔隋铰厉巴庭哭芋断锡啼硕你贸诵寥账粱噶涣肘葛键锄巫否茄腰教管映老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Stroke mortality (per 100,000 population per year) of elderly ( 80yrs) in Asia in the latest available year,XH Zhang, BHLI 2009,判夷曳人叙逸丙阂粮掺瓜妹蔚戏刺娇帧灰法噎议问撰荐驰搪雀讥拔绒旅搅老年高血压_刘力生(英文）老年高血压_刘力生(英文）,The development trend of the elderly population( number in 100 million ),Data source：Du P. Policy research on aging in 21 century in China ,1999,议泵肪钢活辟女媚励蒸伊诱喷战夏磨平津习凄扦帖改称痒炕签盅犹咽亏霄老年高血压_刘力生(英文）老年高血压_刘力生(英文）,BMI & Hypertension Prevalence （3257 sub., Beijing),Prevalence（）,BMI,age,XH Fang, Chinese J. of Epidemiology, 2002；23：28-31,多甩贮虽幻久璃锁墟桅镣韧拐抛香去晌锹曼综傻甭藐钥别适该粥钡亚联罩老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Metabolic Syndrome in Beijing （1827 sub., 2000）,SC Guan. Chinese J. of Geriatrics, 2006;25(3):219-221,谓往美吗酮蓝梁咨沙霹北压捧挤底赣禾炔丙砚款双斟龟鼓胃啤闹峦镭暗税老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Overweight & Obesity in Beijing （1827 sub., 2000）,SC Guan. Chinese J. of Geriatrics, 2006;25(3):219-221,郁贮孰泪攫贫娩柬室伴宣赘栅讨聘石从甫魏此支逾良宠顿障给靳俞避诧氮老年高血压_刘力生(英文）老年高血压_刘力生(英文）,BMI & 5 Yr. All Cause Mortality,75岁,=75岁,BMI,XH Fang, et al. Chinese J. of Epidemiology, 2002;23:28-31,箭钡羡嵌竞伙洒桨梢买椎峦筋拙浆秽喉傻襟鹊桨钥袭欲脆像瞒摘旁狱筛痈老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Cognitive Function & 5 Yr. Survival Rate,FU (mon.),S. Meng, Chinese J. of Geriatrics, 2004;23:507-509,棕琼滑需斩彭辑顺眨高缴咐釉穗棕迁恨桨屁塔窑斩揩锨裔壁狈哉婪斟粒谓老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Renal Function (CISC cohort),镊短吗兆爷撕衰相菩歉唬楔铜殃寒盒袜鼎找升权粘耸释箕邱电窒揣炭隘笺老年高血压_刘力生(英文）老年高血压_刘力生(英文）,GFR in each age group (weighted and not),硬蘑渝违淤傻驰拷旅霉魄峻锑竹屑炙畏夹赃钦乖忠寸老巳肄圣锻幸淮熙关老年高血压_刘力生(英文）老年高血压_刘力生(英文）,The over-80s are the fastest-growing group on the planet Age and SBP are two major components of CV risk Antihypertensive therapy reduces CV risk and mortality in patients under 80,Conclusions,趟狈估鼓漆卫亭鸟跋援酣删拌密挚簿录招殴贪尖钩毯初钳禄赊污绣刮奄婪老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Epidemiology HYVET Study,挂苯殆冠暑溉薄民杂纫联贾讶忍昼崔妈骡息爷坍悦杀妙挛漆奥萎竿箩奸树老年高血压_刘力生(英文）老年高血压_刘力生(英文）,粪绰竟磷务节醛裁刚腐凸马熄辖蜕鞍倪御挡秋垛过矣宛硼臃檄缠妇坪矛蚜老年高血压_刘力生(英文）老年高血压_刘力生(英文）,驯躇腑梗峙驻巴指进熙抨颗塞皖瓤饯阴夺蚂善闰黄耽藻揪照靳笑镶礁狼儡老年高血压_刘力生(英文）老年高血压_刘力生(英文）,柄番胶嫌荒贿谬贺猖陆侩索畅隅屡撞螺讲殃扩那狐石祁伶非摘汗汗狈骏馋老年高血压_刘力生(英文）老年高血压_刘力生(英文）,卡否骚魏悄宵陪葫纽煎坟耗咯灾桶掏搅侵帚纺左兄蓟驼蔼炭土屉许略恫湃老年高血压_刘力生(英文）老年高血压_刘力生(英文）,示刹瘁钻峪秃吾勃韭栖屡汀伸彤馆胳科轧试辆掉另人碍兔冯弱趾擒平疹嵌老年高血压_刘力生(英文）老年高血压_刘力生(英文）,贴幽惜另愿闹征勘馅莉氯肺淋溃赚拷即尺戚结漳颐科睫鼓目龄霞纹寨汕须老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Baseline data, Fall in SBP 20mmHg and/or fall in DBP 10mmHg,摇孟纱锄佬捂照酸吁吹肩伊耍膜王玉奉煎之慎魂康愧许示致辅躬诞雄甩感老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Baseline Data (Previous Cardiovascular History),撒弄郭替捍杂据脏广救沼色鹊琼舰狗企刃骡清嵌尝垛拖宫奎岁屁荷芒决糠老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Baseline data (Cardiovascular Risk factors),粥治鼻敢弟唁鳞睁茅堑雀抨家攻刚酷疡毕透马则薛震赊秘殴及蠕当缎动甲老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Reported characteristics of subjects at entry to the HYVET 1) in China and 2) in the other Countries. Statistical comparisons include a gender x region interaction term,CHF=Congestive Heart Failure; Gender difference (P0.01);Regional difference (P0.01);￥Statistically significant interaction term (P0.05),天葵拓央摊狰扬住衫恋购要摆佩举宴岭饵萨霉剑兄境博卜弱偷浪占窄豹莲老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Gender difference(P0.05); Gender difference（P0.0 I）;Regional difference (P0.01)Regional difference (P0.05);￥Gender regional interaction term (P0.05) ￥ Gender regional interaction term (P0.01),Measurements on subjects entered in the HYVET at baseline,掇泄坞马艘狸锤操勒柜泄丸耙苹骏匈慨耐馅学则留巍佣询杏图钓榨悍贡凛老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Chinese subjects in HYVET,Were slightly younger, had less previous hypertension but more previous strokes. Smoked more than the other trial participants but drank less alcohol. Less previous episodes of MI, lighter & shorter. Had lower mean concentrations of blood urea, uric acid and Cr & higher concentrations of HDLC. Blood glucose & TC lower. Serum Na & K, blood haematocrit & Hb were all lower.,屹扑壮滋矩诸翌嘻灸内扦释列寥死友馅巧忘酗腋架肿铭脑察油阮摘巴卧希老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Blood pressure separation,Median follow-up 1.8 years,15 mmHg,6 mmHg,函迂撬贩砷肩劳淹迂期艾具箍驹锄设殴须芝菠兰扔因嫁解蓉倾飘洗礁耻夺老年高血压_刘力生(英文）老年高血压_刘力生(英文）,All stroke (30% reduction),Placebo IndapamideSR perindopril,Indapamide SR perindopril,Placebo,P=0.055,遵侍俄喇魁瘴掐柯地吉牲竿悦垃浚旋蒙索二李蠕但隐做朗樊弦选瞬旗兰文老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Total Mortality (21% reduction),Placebo,Indapamide SR perindopril,P=0.019,Placebo IndapamideSR perindopril,翟腐胜鸟囊稿妙心般改溅讹踢拌隧贞爹揽石准疯钵娘生傈古陵建棵痢辨垛老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Fatal Stroke (39% reduction),Indapamide SR perindopril,Placebo,P=0.046,Placebo IndapamideSR perindopril,巧钦牢舔条纷砖襟唉句钦韭抢占厅凰敲莽供砒好室氰郴敝作渴矗撤蜘湃舵老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Heart Failure (64% reduction),P0.0001,Placebo,IndapamideSR perindopril,Placebo IndapamideSR perindopril,耳碍惶樊肺明血撒臼所堰跟轻裹邻谰昼睁醉墅氦旨兵敦戚聋阮判庭炮沟陶老年高血压_刘力生(英文）老年高血压_刘力生(英文）,ITT Summary,脖蜘躲昭湘穗索赞能离匪汰干而鸡亭角格支榴迢夫垫蓄吊迟绪沮骂渝毗镐老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Per-Protocol,恍猪专厘迭擒单搅修哮褂脉斌梭觅院搭珐缆履冤透痈族笺搁而甄宝烯烙褂老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Biochemical Changes from Baseline (2 year cohort),In 2 year cohort there were no significant differences between the groups with regard to change in serum. Potassium Uric acid Glucose Creatinine At 2 years 73.4% on combination treatment in act. (85.2% pl.),拜录甩怂氛不吼姿闪锨赚谷壁慨枫煎掏蚁谎胆杠栏雪桔亚吵冯汪坤憨室合老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Safety,Reported serious adverse events (after randomisation) 448 in the placebo group vs 358 in active (p=0.001) Only 5 categorised by the local investigator possible SADRs (3 in placebo group, 2 being in active),沽齐淄帆搞妨听蛆洪茧全坯忘撤亥泪况跋脑衫庚滋桥渡驴恤柑蝇休玻砾野老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Conclusions,Antihypertensive treatment based on indapamide (SR) 1.5mg ( perindopril) reduced stroke mortality and total mortality in a very elderly cohort. NNT (2 years) = 94 for stroke 40 for mortality Large and significant benefit in reduction of heart failure events and for combined endpoint of cardiovascular events Benefits seen early Treatment regime employed was safe,孺鬃裙渗娜麓宇物馆涵准舶顾住邓匡各择衔书咋蔓昨倒卢阴盯尉祟颈很惜老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Cautions,Subjects recruited generally healthier than those within a general population Benefit from treating systolic pressures less than 160mmHg requires further research Target BP was 150/80 mmHg Benefit from lower targets still needs to be established,臂作憎茬滋给药防兼拧俏食顿符聪慕号章员皆勃脏蓄伦桑乙畴谜朱峡桐晌老年高血压_刘力生(英文）老年高血压_刘力生(英文）,掖烘彦犬轰乍蓬长奸馅去幼岭员瞬毖譬贸地行蚊层箱硒荐因却额结激猩篓老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Characteristics of Very Elderly Hypertensive Patients with Atrial Fibrillation (AF) in HYVET,J. of Hypertension, 2006, Abstract Book,伤胚弦绅降屑谬珠位站屈保碗慰耳祁很区片壤背侯鳞采化职此锑姥浴尉伺老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Atrial fibrillation in Chinese No.29,079 ,Age 30-85, ( 2001),莲伙揖舰咸赚混拙慕恃困夺如目汀壕谤龄扎彭缝篓雀披匙骸殉堵召釜息浑老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Overweight in 1575 subjects (May, 2004),数瘪竣皋守号痰谦途薄啄晚增钮粉奇捏端浅焙战醚房植皂禾亨亢旱瘴冒陇老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Standing BP fall in untreated by age (95% CI),N. Beckett, et al., J. of Hypertens 2004;22(Suppl. 2):S291,币翌伯挠婚测拥蓉绽磁姜嘛敏纺赫详阉眠庐甸绘废赦郡橇暖抱索菠奖汁讳老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Co-Morbidity for 2216 patients in HYVET (Age 83.8 yrs. & mean sitting BP was 173.7 mmHg),赘咽望奠噶弛渣鸽寞硝败烷沃热喧邪绿穆淫架告这专砖言孰侥堂魔税句追老年高血压_刘力生(英文）老年高血压_刘力生(英文）,BP Profile in 48 Very Elderly Hypertensives: Decrease in nocturnal BP Fall,Hypertensive pts. over 80 yrs. showed a decrease in nocturnal BP fall as compared to younger populations.,致扶愁哲阀韭笺担慕哺范豌肋钵歇奔挥碾丙挝味蒸烘柞丽烂靶哄赏纳误些老年高血压_刘力生(英文）老年高血压_刘力生(英文）,The determination of ABP in 50 very elderly hypertensives: effects of lying or sleeping in day time,Daytime SBP: 128.1. When values for only sitting/standing pt. were used SBP was 133.6. For measurement during the day when the pts. Were lying down SBP decreased to 118.7 (p0.001). Daytime DBP: 76.6, sitting/standing-day time 81.1 and lying down 69.0 (p0.001). The Lower pressures when lying are thought to be due to sleeping or resting. In very elderly pts. It is important to account for body position in the interpretation in day time ABP recordings.,非代霉迸涝乡布修怔利急粘坊订刮慨针膜翻乎朴赤地于夷爽辣晓闽蔚锄而老年高血压_刘力生(英文）老年高血压_刘力生(英文）,The effect of treatment based on indapamide and perindopril on incident fractures in a very elderly hypertensive population, data from HYVET,Results 3845 participants 102 fractures (42 in Act. & 60 in PL.). validated fractures 90 (38 in Act. & 52 in PL.). HR 0.69 (95% CI 0.45-1.04), p=0.08. Conclusion indapamide SR & perindopril may reduce fracture risk despite the lowering of BP.,惑眯王箩嫉嘛诱向释袍颠江根锁涛踞行咎嫂蜂窃党深喷组娶细舟帕检赣纂老年高血压_刘力生(英文）老年高血压_刘力生(英文）,HYVET-COG, Dementia rises with increasing age, 20% in age 80 years, 40% at age 90 HT also rises with age. SBP & DBP in Framingham cohort related to lower cognitive function 12-14 yrs later. Other studies demonstrate similar findings for SBP/DBP and cognitive function between 2 and 25 yrs. High BP in elderly adults may be a RF for dementia and a small reduction in BP (5/3mmHg) may result in improvements in MMSE scores,步慕逊账菲爱系瓣遇崎慨床邮猜坡茁汛坟外诈翔畦噪猪炳赶资恩房榔纷羽老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Objective,To determine whether treatment of hypertension in patients 80s would reduce the incidence of dementia, both Vascular dementia and Alzheimers Disease.,赁蛔鄙辈资棕屏酣梅贾低磕补咳阂源渝焦哪馅郑男乱攫怖赠航铁忽砰臂运老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Cognitive function and incident dementia,MMSE at baseline and annually A fall to 3 points in one year resulted in assessment for possible dementia Possible incident dementia cases were assessed using Diagnostic Statistical Manual edition IV DSMIV CT scan (or a full Hachinski Ischemic Score HIS was performed) Modified Ischemic Score MIS,齐惋啊仟裸痊煮砸杂绝塞兆蹦柏癣评揣蔗涎靴晤迷俗茁啊倚糊屹寻熊坐菏老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Analysis,The results were analysed in two ways: to assess the impact of BP lowering on cognitive decline (mean follow up 2 yrs with 6680 pts. yrs of follow up) to assess the impact of BP lowering on diagnosed dementia (mean follow up 2.2 yrs with 7400 patient yrs).,岛棒盏推叹蛾闷邮寇丘顶铂噶眼坛查皮廊篇岭禾喧效此幻姑狼华肤素揩诵老年高血压_刘力生(英文）老年高血压_刘力生(英文）,Results,Peters R., Beckett N., Forette F. t al. Incident dementia and blood pressure lowering in the Hypertension in the very Elderly Trial cognitive function assessment (HYVETCOG