【高血压英文PPT精品课件】 Hypertension

1、what is hypertension? blood pressure (mm hg)category systolicdiastolic 120and 80normal 120-139or 80-89prehypertension 140-159or 90-99stage 1 hypertension 160or 100stage 2 hypertension jnc 7 definitions chobanian av, et al. hypertension 2003;42:1206-52 *individuals aged 40-69 years, starting at blood

2、 pressure 115/75 mm hg. cv, cardiovascular; dbp, diastolic blood pressure; sbp, systolic blood pressure. chobanian av et al. jama. 2003;289(19):2560-2572. lewington s et al. lancet. 2002;360(9349):1903-1913. cardiovascular mortality risk doubles with each 20-mm hg sbp or 10-mmhg dbp increment* cardi

3、ovascular mortality risk sbp/dbp (mm hg) 0 1 2 3 4 5 6 7 8 115/75135/85155/95175/105 2x 4x 8x non-hispanic whitenon-hispanic blackmexican american men (age, years) hypertension* prevalence (%) 18-3940-5960 0 20 40 60 80 100 women (age, years) 18-3940-5960 0 20 40 60 80 100 hypertension* prevalence (

4、%) *hypertension defined as a bp of 140/90 mm hg or reported use of antihypertensives. error bars indicate 95% confidence intervals. data are weighted to the us population. hajjar i, kotchen ta. jama. 2003;290:199-206. prevalence of hypertension increases with age: nhanes 1999-2000 data nhanes = nat

5、ional health and nutrition examination survey. fields, le et al. hypertension. 2004;44:398-404. increasing prevalence of hypertension: rise from 1988 to 2000 (nhanes) 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 non-hispanic whites non-hispanic blacks mexican americans % increase (19881994 to 19992000) men women

6、 blacks have a higher prevalence and incidence of hypertension than whites. most studies in the united kingdom and the united states report a higher prevalence and lower awareness of hypertension in black people than in white people. in mexican-americans, the prevalence and incidence of hypertension

7、 is similar to or lower than in whites. nhanes iii reported an age- adjusted prevalence of hypertension at 20.6% in mexican-americans and 23.3% in non-hispanic whites. group htn prevalence white 21.2% black/african-american 29.2% hispanic/latino 19.6% asians 16.9% native hawaiian/other pacific islan

8、der 20.7% american indians/alaska natives 25.4% american heart association heart disease and stroke statistics 2007 hypertension prevalence by ethnic/minority groups contributing factors: social, environmental, or genetic? environmental factors ultimately related to race (e.g. socioeconomic disadvan

9、tage, less access to health care) play roles in causing and sustaining hypertension 1, 2 despite similar african heritage, africans living in africa or west indies have much less hypertension than african americans 3,4 in rural africa, hypertension prevalence is very low and blood pressure does not

10、rise with age as it does in all ethnic groups in us 3 1 cooper rs, rotimi cn, ward r. the puzzle of hypertension in african-americans. sci am. 1999;280:5662. 2 geronimus at, bound j, waidmann ta, et al. excess mortality among blacks and whites in the united states. n engl j med. 1996;335(21):1552155

11、8. 3 cooper r, rotimi c, ataman s, et al. the prevalence of hypertension in seven populations of west african origin. am j public health. 1997;87:160168. 4 ordunez-garcia po, espinosa-brito ad, cooper rs, et al. hypertension in cuba: evidence of a narrow black-white difference. j hum hypertens. 1998

12、;12:111116. bp reductions as small as 2 mm hg reduce risk of cv events by up to 10% meta-analysis of 61 prospective, observational studies 1 million adults 12.7 million person-years prospective studies collaboration. lancet. 2002;360:1903-1913. 2 mm hg decrease in mean sbp 10% reduction in risk of s

13、troke mortality 7% reduction in risk of chd mortality bplttc meta-analysis: stroke and chd blood pressure lowering treatment trialists collaboration. lancet. 2003;362:1527-1535. jnc7 algorithm for treatment of hypertension not at goal bp 140/90 mm hg for most 130/80 for those with diabetes or ckd in

14、itial drug choices drug(s) for compelling indications + bp meds as needed compelling indications lifestyle modifications stage 2 bp 160/100 2-drug combo for most (diuretic + acei, or arb, or bb, or ccb) stage 1 140-159/90-99 diuretics for most; consider acei, arb, b, ccb no compelling indications no

15、t at goal bp optimize dosages or add drugs until goal bp is achieved. consider hypertension specialist consult. chobanian av, et al. jama. 2003;289:2560-2572. acei = ace inhibitor ccb = calcium channel blocker arb = angiotensin receptor blocker b = -blocker ckd = chronic kidney disease jnc 7 compell

16、ing indications chobanian av, et al. jama. 2003;289:2560-2572. heart failure post-mi high chd risk diabetes chronic kidney disease recurrent stroke prevention b acei arb ccb aadiuretic aa = aldosterone antagonist aha perspective/hypertension management and bp goals summary of main recommendations ad

17、apted from rosendorff c, et al. circulation 2007;115:published online area of concern bp target (mm hg) lifestyle modificationspecific drug indications general cad prevention140/90yesany effective antihypertensive drug or combination high cad risk*130/80yesacei or arb or ccb or thiazide or combinati

18、on stable angina130/80yes-blocker and acei or arb ua/nstemi130/80yes-blocker and acei or arb stemi130/80yes-blocker and acei or arb lvd120/80yesacei or arb and -blocker and aldo antagonist and thiazide or loop diuretic and hydral/nitrate (blacks) * diabetes, ckd, cad or equivalent weight loss if app

19、ropriate, healthy diet, exercise, smoking cessation and alcohol moderation evidence supports acei or arb, ccb, or thiazide as first-line if anterior mi is present, if htn persists, if lvd or hf is present, if diabetic lose weight if overweight limit alcohol intake to no more than 1 oz (30 ml) of eth

20、anol (ie, 24 oz 720 ml of beer, 10 oz 300 ml of wine, 2 oz 60 ml of 100- proof whiskey) per day or 0.5 (15 ml) ethanol per day for women and people of lighter weight increase aerobic activity (30-45 min most days of the week) reduce sodium intake to no more than 100 mmol/d (2.4 g sodium) maintain ad

21、equate intake of dietary potassium (approximately 90 mmol/d) maintain adequate intake of dietary calcium and magnesium for general health stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health jnc vii recommendations.chobanian av, et al. jama. 2003;

22、289:2560-2572. modification approximate sbp reduction (range) weight reduction 5-20 mmhg / 10 kg weight loss adopt dash eating plan8-14 mmhg dietary sodium reduction2-8 mmhg physical activity4-9 mmhg moderation of alcohol consumption 2-4 mmhg huang z et al. ann intern med. 1998;128:8188. poor compli

23、ance to lifestyle modifications acceptance of inadequate control by physician difficulty achieving bp control with one agent/suboptimal regimens bp goals are more aggressive than in previous years lack of compliance due to: perceived side effects of antihypertensive medication(s) frequency of dosing

24、/multiple agents to attain control (adapted from jnc vi. arch intern med. 1997) yesno cure of hypertension take medications for life take medications only with symptoms having at least one non- biomedical expectation having all three nonbiomedical expectations nonbiomedical expectations 38% 48% 23%

25、65% 15% 51% 38% 67% 35% 85% 11% 14% 10% 0% 0% dont know ogedegbe g. j natl med assoc. 2004;96:442449. *computed by m. wolz (unpublished data cited by chobanian et al.) adapted from chobanian av, et al. jama. 2003;289:2560-2572. nhanes iii 19911994 nhanes iii 19881991 adults, % patient awareness nhan

26、es ii 19761980 treatment control 19992000* 51 73 68 31 55 54 10 29 27 70 59 34 0 10 20 30 40 50 60 70 80 age-adjusted blood pressure control rates in different groups group hbp control 2003-04 mexican-american men31.1% mexican-american women 24.6% non-hispanic white men34.8% non-hispanic white women

27、41.8% non-hispanic black men26.8% non-hispanic black women30.3% adapted from materson bj et al. am j hypertens. 1995;8:189192. *response=diastolic blood pressure (dbp) 90 mmhg at the end of titration period and having maintained a dbp of 4 drug therapy young age of onset of htn (teens, 20s) sudden i

28、ncrease in bp episodes of extreme bps low potassium 163:525-541 if bp 145/90 mm hg, monotherapy or combination therapy including a ras blocker if bp 155/100 mm hg, monotherapy if bp 155/100 mm hg, combination therapy add a 2nd agent from a different class or increase dose increase dose or add a 3rd

29、agent from a different class uncomplicated hypertension goal bp: 1 gm/24 h is 1 g/24 h* goal bp: 130/80 mm hg not at bp goal? intensify lifestyle changes and patient with elevated bp the majority of patients will require combination therapy to achieve target bp. effective combinations are: beta bloc

30、ker/diuretic ace inhibitor/diuretic ace inhibitor/ccb arb/diuretic douglas jg et al. (ishib haawg) arch intern med. 2003;163:525-541. chobanian av et al. (jnc 7) jama. 2003;289:25602572 jnc 7: if bp exceeds goal by 20/10 mmhg begin combination therapy ishib consensus statement: if bp exceeds goal by

31、 15/10 mmhg begin combination therapy rf = risk factor. kannel wb. am j hypertens. 2000;13:3s-10s. 26% 25% 22% 8% 19% men 3 rfs 4 rfs 2 rfs no additional rfs 5 rfs women 27% 24% 20% 12% 17% 3 rfs 4 rfs 2 rfs no additional rfs 5 rfs framingham offspring (ages 18 to 74 years) with hypertension are likely to have additional risk factors risk-factor clustering in patients with hypertensio