老高血压患者的治疗.ppt

ACCinChinaHypertension,PreventionandLipids(HPL),JiguangWANG,MD,PhDShanghaiInstituteofHypertension,RuijinHospital,Shanghai,Chinajiguangwgmail,Managementofhypertensionintheelderly,JiguangWANG,MD,PhDShanghaiInstituteofHypertension,RuijinHospital,Shanghai,Chinajiguangwgmail,Sizeoftheproblem:hypertensionCarefulselectionofantihypertensivedrugstopotentiatethehugebenefitandtoavoidthepotentialharmRoadmaptocontrolbloodpressureinresistanthypertensivepatients,Awareness,treatmentandcontrolratesofhypertensioninChina,ChinJHypertens2019;3(suppl):14-18;LiLiming,etal.ChinJEpidemiol2019;26:,478-484.,Sizeoftheproblem:hypertensionCarefulselectionofantihypertensivedrugstopotentiatethehugebenefitandtoavoidthepotentialharmRoadmaptocontrolbloodpressureinresistanthypertensivepatients,Relativeriskreductionsbyantihypertensivetreatmentinearlytrials,ProgressiontosevereHT,CHF,Stroke,CHD,Totalmortality,CVmortality,-94*,-53%*,-40%*,-16%*,-13%,-21%*,*P0.05,CollinsRetal.BrMedBull1994;50:272-298.,BPLTTC.Lancet2019;362:1527-45.,0-5-10-15-20-25-30,Stroke,CHD,CHF,Totalmortality,-23%,-15%,-16%,-14%,4/3mmHg,N20888,MajorCVevents,-15%,Relativeriskreductionsbyantihypertensivetreatmentinrecenttrials,指南推荐,利尿剂阻滞剂钙离子拮抗剂转换酶抑制剂血管紧张素受体拮抗剂,JHypertens2019;25:1105-87.,INTERMAP:Urinaryelectrolytesinmen,ZhouBFetal.JHumHypertens2019;17:623630.,INTERMAP:Urinaryelectrolytesinwomen,ZhouBFetal.JHumHypertens2019;17:623630.,HYVET:Serumconcentrationsofcholesterol,sodiumandpotassium,LiuLSetal.ChinMedJ2019;121:1509-1512.,SHEP:New-onsetdiabetesmellitus,ShafiTetal.Hypertension2019;52:1022-9.,45%per0.5mmol/LinK+,Sizeoftheproblem:hypertensionCarefulselectionofantihypertensivedrugstopotentiatethehugebenefitandtoavoidthepotentialharmRoadmaptocontrolbloodpressureinresistanthypertensivepatients,ResistantHypertension:Diagnosis,Evaluation,andTreatment.AScientificStatementFromtheAHAProfessionalEducationCommitteeoftheCouncilforHighBPResearchHypertension2019,Pharmacologicrecommendationsforthetreatmentofresistanthypertension(1),Useofalong-actingthiazidediuretic,preferablychlorthalidoneCombineagentswithdifferentmechanismsofactionRecommendedtripleregimenof-ACEinhibitororARB-Calciumchannelblocker-Thiazidediuretic,Consideradditionofmineralocorticoidreceptorantagonist.UseofloopdiureticmaybenecessaryinpatientswithCKD(creatinineclearance30mL/min).,Pharmacologicrecommendationsforthetreatmentofresistanthypertension(2),NumberNo.drugs2drugsALLHAT42,4241.840%ANBP260832.050%ASCOT19,2572.378%CONVINCE16,6021.840%INVEST22,5763.085%LIFE91932.046%VALUE15,2452.054%,NumberofdrugsinrecentlargeHTtrials,Achieved135/76147/82136/77136/79131/76144/81138/78,Catheter-BasedRenalSympatheticDenervationfortheManagementofResistantHypertension,HenryKrumMBBSPhDFRACPCentreofCardiovascularResearchAlfredHeartCentre,TheAlfredHospital,Melbourne,Australia,Treatments,Catheter-BasedRenalSympatheticDenervationfortheManagementofResistantHypertension,HenryKrumMBBSPhDFRACPCentreofCardiovascularResearchAlfredHeartCentre,TheAlfredHospital,Melbourne,Australia,Results:BloodPressureReduction,87%hadareductioninSBP10mmHg,P0.001exceptforDBPat12months(P=0.02),Conclusions,Therapeuticrenalsympatheticdenervationproducedpredictable,significant,andsustainedreductionsinBPinpatientswithresistanthypertension.Thebriefandsimpleprocedurewasperformedwithoutsignificantcomplicationstoeithertherenalarteryorthekidney.Resultsappearbothtoconfirmtheimportantroleofrenalsympatheticnervesinresistanthypertensionandtosuggestthatrenalsympatheticdenervationcouldbeoftherapeuticbenefitinthispatientpopulation.Prospectiverandomizedclinicaltrialsexaminingthetreatmentofhypertensionarebeginningin2009,andtrialsinheartfailureandchronickidneydiseaseareanticipated.,因为知晓率低、用药后血压控制率低，我国90%以上的高血压患者的血压未得到有效控制(140/90mmHg)，在广大农村该比例甚至高达96.5%。因此，必需大幅度提高高血压检出率与治疗控制率。指南推荐使用的5大类降压药物均可在50%以上的患者中发挥