The Relationship of Systolic and Diastolic Blood Pressure to ：收缩压和舒张的关系.ppt

therelationshipofsystolicanddiastolicbloodpressuretocardiovasculardiseaserisk observationaldata prevalenceofhypertensionintheus percenthypertensive 18 29 basedonnhanesiii phase1and2 hypertensiondefinedasbloodpressure 140 90mmhgortreatment 30 39 40 49 50 59 60 69 70 79 80 age 3 9 18 38 51 66 72 jnc vi archinternmed 1997 157 2413 2446 riskofhypertension residuallifetimeriskofdevelopinghypertensionamongpeoplewithbloodpressure 140 90mmhg years lifetimeriskofdevelopinghypertensionbeginningatage65 men women vasanrs etal jama 2002 287 1003 1010 copyright2002 americanmedicalassociation mortalityaccordingtobloodpressureinmenage50to69 societyofactuaries bloodpressurestudy 1939 ratio ofactualtoexpectedmortality systolicbloodpressure mmhg diastolicbloodpressure mmhg age adjustedannualincidenceofchdper1000 basedon30yearfollow upofframinghamheartstudysubjectsfreeofcoronaryheartdisease chd atbaseline systolicbloodpressure mmhg bloodpressureandriskforcoronaryheartdiseaseinmen diastolicbloodpressure mmhg age65 94 age35 64 age65 94 age35 64 framinghamheartstudy 30 yearfollow up nhlbi 1987 relativeriskofchdmortality hej etat amheartj 1999 138 211 219 copyright1999 mosbyinc 112 71 riskofchddeathaccordingtosbpanddbpinmrfit decile 112 71 118 76 121 79 125 81 129 84 132 86 137 89 142 92 151 98 lowest10 highest10 sbp mmhg dbp mmhg systolicbloodpressure sbp diastolicbloodpressure dbp chd coronaryheartdisease relativeriskofstrokedeath 112 71 riskofstrokedeathaccordingtosbpanddbpinmrfit decile 112 71 118 76 121 79 125 81 129 84 132 86 137 89 142 92 151 98 lowest10 highest10 sbp mmhg dbp mmhg systolicbloodpressure sbp diastolicbloodpressure dbp hej etat amheartj 1999 138 211 219 copyright1999 mosbyinc age adjustedannualcvdeventrateper1000 wilkingsvetal jama 1988 260 3451 3455 men women isolatedsystolichypertensionandcvdriskinframingham ishbp 160 95mmhgbp 140 95mmhg 82 43 33 2 4 18 2 5 cvd cardiovasculardiseaseish isolatedsystolichypertensionp 0 001fordifferencebetweenbothmenandwomenwithishandbloodpressure bp 140 95mmhg therelationshipofhypertensiontreatmenttocvdriskreduction introduction incidenceofcardiovasculardisease 120 hypertensiontreatmenteffectmirrorsobservationaldata 140 160 180 200 220 observationaldata treatmenteffect systolicbloodpressure mmhg landmarkclinicaltrialshypertensiontreatmentandcardiovasculardiseaseoutcomes 1967 vacooperativestudyondbp115 1291970 vacooperativestudyondbp90 1141979 hdfp1980 australiantrial oslotrial1985 mrci ewphe1991 shep stop hypertension1992 mrciiintheelderly1997 syst eur2002 life2002 allhat relativeriskforcoronaryheartdisease oddsratiosand95 confidenceintervals 0 0 5 1 1 5 2 0 79 0 69to0 90 hej etal amheartj 1999 138 211 219 copyright1999 mosby inc activetreatmentbetterthanplacebo activetreatmentworsethanplacebo relativeriskforstroke 0 0 5 1 1 5 2 0 63 0 55to0 72 oddsratiosand95 confidenceintervals activetreatmentbetterthanplacebo activetreatmentworsethanplacebo hej etal amheartj 1999 138 211 219 copyright1999 mosby inc theveteransadministrationcooperativestudyonantihypertensiveagents thevacooperativestudy 1967 vacooperativestudygroup jama 1967 202 1028 1034 hctz hydrochlorothiazide 12 12 thevacooperativestudy 1967 changeinsystolicanddiastolicbloodpressure changeinsystolicbp mmhg percentofpatients percentofpatients changeindiastolicbp mmhg 76 60 44 28 0 28 decrease increase activedrugs placebo activedrugs placebo vacooperativestudygroup jama 1967 202 1028 1034 copyright 1967 americanmedicalassociation 12 12 76 60 44 28 0 28 decrease increase thevacooperativestudy 1967 assessablemorbid fatalevents vacooperativestudygroup jama 1967 202 1028 1034 p 0 001activedrugtherapyvsplacebo thevacooperativestudy 1967 conclusions theactivelytreatedgroupexperiencedareductioninmultiplehypertension relatedendpoints21morbid fataleventsonplacebo1morbid fataleventonactivetherapy vacooperativestudygroup jama 1967 202 1028 1034 thevacooperativestudy 1970 vacooperativestudygroup jama 1970 213 1143 1152 thevacooperativestudy 1970 assessablemorbid fatalevents vacooperativestudygroup jama 1970 213 1143 1152 p 0 001activedrugtherapyvsplacebo thevacooperativestudy 1970 conclusions activetreatmentreducedfatalandnonfatalendpointsasubsequentanalysisrevealedthatbenefitswerestatisticallysignificantonlyforthosewithbaselinediastolicbloodpressure105 114mmhg vacooperativestudygroup circulation 1972 45 5 991 1004 vacooperativestudygroup jama 1970 213 1143 1152 theeuropeanworkingpartyonhighbloodpressureintheelderly 1985 theeuropeanworkingpartyonhighbloodpressureintheelderly 1985 amerya etal lancet 1985 1 1349 1354 survivalfreeofevent yearoffollow up ewphecardiovascularmortalityon treatmentanalysis active n 416 placebo n 424 p 0 023 amerya etal lancet 1985 1 1349 1354 reprintedwithpermissionfromelsevierscience ewphe europeanworkingpartyonhighbloodpressureintheelderly ewpheconclusions activetreatmentreducedcardiovascular cv mortality largelyduetoareductionincardiacmortalityolderpatients 60yrsold withcombinedsystolicanddiastolichypertensionwhoreceivedactivetherapyexperienced29fewercveventsand14fewercvdeathsper1 000patient yearsoftreatment amerya etal lancet 1985 1 1349 1354 ewphe europeanworkingpartyonhighbloodpressureintheelderly thehypertensiondetectionandfollow upprogram 1979 thehypertensiondetectionandfollow upprogram 1979 hdfpcooperativegroup jama 1979 242 2562 2571 cumulativemortality 0 1 3 6 yearoffollow up hdfpmortalityratesentirecohort 2 4 5 referredcare steppedcare hdfp hypertensiondetectionandfollow upprogram p 0 01 hdfpcooperativegroup jama 1979 242 2562 2571 n 5 456 n 5 485 0 1 3 6 2 4 5 cumulativemortality hdfpmortalityratesdiastolicbp90 104mmhg referredcare steppedcare hdfp hypertensiondetectionandfollow upprogram yearoffollow up p 0 01 hdfpcooperativegroup jama 1979 242 2562 2571 n 3 822 n 3 903 bp bloodpressure hdfpconclusions overall steppedcare sc comparedtoreferredcare rc reducedtotalmortalityby17 6 4vs 7 7 p 0 01 inpatientswithbaselinediastolicbloodpressure90 104mmhg n 7 725 mortalitywasreducedby20 withscvs rc 5 9 vs 7 4 p 0 01 aggressivetreatmentofscpatientswiththelowestbaselinediastolicbloodpressures 90 94and95 99mmhg reducedmortality hdfp hypertensiondetectionandfollow upprogram hdfpcooperativegroup jama 1979 242 2562 2571 thesystolichypertensionintheelderlyprogram 1991 thesystolichypertensionintheelderlyprogram 1991 shepresearchgroup jama 1991 265 3255 3264 bp bloodpressure changeinbp mmhg years shepchangeinbloodpressure placebo n 2 371 activerx n 2 365 years systolicbp diastolicbp shepresearchgroup jama 1991 265 3255 3264 copyright 1991 americanmedicalassociation bp bloodpressure shep systolichypertensionintheelderlyprogram placebo n 2 371 activerx n 2 365 bloodpressure mmhg 0 12 36 60 monthsoffollow up shepaveragebloodpressureduringfollow up 24 48 0 shep systolichypertensionintheelderlyprogram shepresearchgroup jama 1991 265 3255 3264 copyright 1991 americanmedicalassociation cumulativestrokerateper100persons 0 12 36 60 monthsoffollow up shepcumulativestrokerate 24 48 72 p 0 0003 placebo n 2 371 activerx n 2 365 shep systolichypertensionintheelderlyprogram shepresearchgroup jama 1991 265 3255 3264 copyright 1991 americanmedicalassociation relativerisk 95 ci stroke chd activetherapyvs placebo chf death 0 63 0 46 0 68 0 87 cvd 0 75 shepcardiovasculardiseaseendpoints shepresearchgroup jama 1991 265 3255 3264 shep systolichypertensionintheelderlyprogram chd coronaryheartdisease chf congestiveheartfailure cvd cardiovasculardisease shepconclusions shepwasthefirstclinicaltrialtodemonstratethatreductionofbloodpressureinpatientswithisolatedsystolichypertensionreducedcardiovascular cv mortalitytherelativeriskofstrokewasreducedby36 withtherapycomparedtoplacebo p 0 0003 the5 yearabsolutebenefitswereareductionin30strokesand55majorcvdiseaseeventsper1 000persons shepresearchgroup jama 1991 265 3255 3264 shep systolichypertensionintheelderlyprogram thesystolichypertensionineurope syst eur trial 1997 thesystolichypertensionineuropetrial 1997 staessenja etal lancet 1997 350 757 764 systolicbp mmhg syst eurmeansittingsystolicbloodpressure 0 placebo n 2 297 activetreatment n 2 398 1 2 3 4 yearssincerandomization staessenja etal lancet 1997 350 757 764 reprintedwithpermissionfromelsevierscience syst eur systolichypertensionineuropetrial p 0 001 syst eurmeansittingdiastolicbloodpressure 0 1 2 3 4 diastolicbp mmhg placebo n 2 297 activetreatment n 2 398 p 0 001 yearssincerandomization staessenja etal lancet 1997 350 757 764 reprintedwithpermissionfromelsevierscience syst eur systolichypertensionineuropetrial eventsper100patients syst eurprimaryendpointfatalandnonfatalstroke placebo n 2 297 activetreatment n 2 398 p 0 003 yearssincerandomization staessenja etal lancet 1997 350 757 764 reprintedwithpermissionfromelsevierscience syst eur systolichypertensionineuropetrial percentagerelativeriskreduction 95 ci stroke mi activetherapyvs placebo chf death 42 p 0 003 29 31 p 0 001 14 allcvd 30 syst eurcardiovasculardiseaseendpoints staessenja etal lancet 1997 350 757 764 mi myocardialinfarction chf congestiveheartfailure cvd cardiovasculardisease syst eur systolichypertensionineuropetrial syst eurconclusions oldermenandwomenwithisolatedsystolichypertensionwhoreceivedactivetreatmentwithadihydropyridinecalciumchannelblockerexperiencedfewerstrokesandcardiovasculardisease cvd eventsthanthosereceivingplacebo treatmentof1 000patientsfor5yearswiththistypeofregimencouldprevent29strokesor53majorcvdendpoints staessenja etal lancet 1997 350 757 764 syst eur systolichypertensionineuropetrial theaustraliannationalbloodpress