H型高血压优化防治方案

H型高血压优化防治方案,2007年,我国脑卒中发病率不断上升,亚太NO1,2020年,脑卒中180万/年,脑卒中发病将达370万/年,8.7%/年,Zhao et al, Stroke, 2008 (国际“卒中”杂志上发表的中国-MONICA-北京调查结果 ),东西方心脑血管疾病分布差异,AHA Heart Disease and Stroke Statistics -2009 update,Report on CVD in China 2006Fourth National Survey on Health Service /publicfiles,患病例数（百万）,NOTES: Estimates are age-adjusted. Starting with 1999 data,causes of death were coded according to ICD10.,SOURCE: CDC/NCHS, National Vital Statistics System.,Chartbook,Health, United States, 2008,冠心病和脑卒中死亡率趋势及中美比较,Stroke,1950,1960,1970,1980,1990,2000,2005,Year,10,000,100,10,Deathsper100,000population(logscale),Heart disease,1985,1990,1995,2000,2005,Year,150,100,0,Mortality(1/100000),50,USA,Lisheng Liu, Cardiovascular diseases in China, Biochem. Cell Biol. 85: 157163 (2007),Stroke,CHD,138,54,211.1,46.6,China,Asian Pacific Region Stroke (2002),127.6,105.9,97.3,72.6,68.4,65.5,57.0,56.3,43.2,42.4,41.0,39.9,31.0,0,20,40,60,80,100,120,140,China,Japan,South Korea,Vietnam,Myanmar,Laos,Indonesia,USA,Cambodia,Malaysia,Singapore,Thailand,Philippines,Incidence per 100,000,Atlas of Heart Disease and Stroke. MacKay J & Mensah G. 2004. Geneva. WHO Figures (not adjusted for age).,Stroke is more common than MI in Hypertension-Analysis based on 11 Major Randomized Intervention Trials,STOP-1 SHEPSTONE*SYST-EURSYST-CHINA*HOTCAPPPSTOP-2NICS*NORDILINSIGHT,19911991199619971998199819991999199920002000,7672677067615376706067,162747361632469523941879010985661441410886575,822695212410429434045220355141,53165478162093272934340138,Year ofPublication,Average age (yrs),No.patientsrandomized,No.strokes,StudyAcronym,Total 2233 1627 1.37,Blood Pressure 2001; 10: 190-2,* Studies were conducted in China* Study was conducted in Japan,Stroke:MIratio,1.54 1.6313.00 1.58 6.56 1.41 1.04 1.54 5.00 1.04 1.02,No.MI,传统”三高”无法解释中国脑卒中高发现象,潜伏的答案HCY,SOURCE: CDC/NCHS, National Vital Statistics SystemReport on Cardiovascular Diseases in China (2008-2009)N Engl J Med 2006;2010；北京大学学报(医学版) 2007(39),欧洲：荟萃分析结论,BMJ,2002,325:1202-1206,中国39165例10年跟踪hcy流行病学研究,* Li J et al. 2009 (paper under review),Hcy水平,发生概率,中国:安庆社区研究,最新欧洲指南：Hcy是动脉粥样硬化和脑卒中/TIA的独立危险因素,中国新指南，重视中国特点,我国是脑卒中的高发区，高血压的主要并发症是脑卒中血同型半胱氨酸升高水平与脑卒中风险正相关，降低同型半胱氨酸显著降低脑卒中我国高血压人群伴有Hhcy*比例较高（H型高血压占75%）HHcy*是影响高血压患者心血管事件预后的重要因素，指导高血压高危分层管理HHCY*检测具有临床诊断、筛查和防治干预价值的界值10mol/L价格低廉的多效固定复方制剂“依那普利/叶酸片” ，具有降低心脑血管事件综合干预的优效性,* HHCY 高同型半胱氨酸血症缩写,JANA.2004；7；11-24Circulation 2006;113;e409-e449,2006年美国AHA指南，高同型半胱氨酸血症 10umol/L,心脑血管可防可控的“五高”危险因素,1、JAMA. 1997;277:1775-17812、Diabetes Care 1999; 22(2):233-240. 3、Epidemiology，1999，10(4)：391,高Hcy与高血压显著增加血管疾病风险,JAMA. 1997,277:1775-1781,中国H型高血压发生率*,* AHA,血浆thcy10umol/L,* Beijing Da Xue Xue Bao2007;39:614-8,中国：75%高血压患者伴有高HCY,H型高血压（H-type Hypertension）,伴有血浆同型半胱氨酸升高(Hcy10umol/L)的原发性高血压定义为H型高血压Hypertensive patients, co-morbi