高血压讲课课件

1、高血压1diseases of circulatory system hypertensionprof. shen-jiang hu高血压2n掌握高血压的诊断标准、危险分层和治疗原则。n熟悉降压药物的种类及特点；降压药物的选择和联合用药。n了解高血压的患病率、病因、发病机制和并发症；以及较常见的几种继发性高血压。 讲授目的和要求高血压31、内科学，王吉耀主编，人民卫生出版社2、实用高血压学余振球等主编，科学出版社3、现代内科学英语精要王吉耀、刘文忠摘编，人民卫生出版社 教材及参考书教材及参考书 高血压4教学网站网址教学网站网址 n内科学校级精品课程：n内科学省级精品课程： 高血压5blood

2、pressure has a unimodal distribution in the population高血压6“hypertension may be an important compensatory mechanism which should not be tampered with, even were it certain that we could control it.”white pd, 1931“高血压可能是一个重要的代偿机制，即使我们能够控制它，也不应高血压可能是一个重要的代偿机制，即使我们能够控制它，也不应该处理它。该处理它。”“the greatest dange

3、r to a man with high blood pressure lies in its discovery, because then some fool is certain to try to reduce it.”hay j, 1931高血压7人类对高血压认识的历史framingham心脏研究：最早认识到高血压与心脏病的关系1961年认识到高血压与卒中的关系1970年世界卫生组织首次提出高血压阶梯治疗方案1978年jnc ii将舒张压作为确诊高血压的和治疗建议的基础1980年jnc v收缩压与舒张压同等重要1992年jnc vii：降压达标对减少各类患者的心血管事件至关重要200

4、3年中国高血压治疗指南更新：降压药物治疗目标在于，降低血压使其达到相应病人的目标水平2005年世界卫生组织将“降压要达标”作为高血压日的宣传口号2006年高血压8atrial fibrillationaortic dissectiondementiachronic renal failureheart failurelv hypertrophymihypertensive encephalopathychdintracerebral hemorrhageischemiccerebralinfarctioncomplications of hypertension高血压9the relation

5、ship between blood pressure and cardiovascular events高血压10高血压11definition of hypertensionnhypertension is a clinical syndrome, defined as systolic blood pressure 140 mmhg and/or diastolic blood pressure 90 mmhg. nhypertension should be considered a major risk factor for an array of cardiovascular an

6、d related disease as well as diseases leading to a marked increase in cardiovascular risk. 。hypertension in china(1991)死亡原因 死亡率占总死亡死亡原因 死亡率占总死亡 1/10万%1/10万 %循环系病226.138.5 内分泌，代谢 - 脑血管病127.221.6 营养，免疫病16.92.9 - 心脏病98.916.8 泌尿生殖病 8.91.5恶性肿瘤40.523.9 精神病6.71.1呼吸系病81.713.9 神经病5.30.9损伤，中毒36.96.3消化系病17.93.

7、0我国城市我国城市19991999年前年前1010位死亡原因位死亡原因我国农村我国农村19991999年前年前1010位死亡原因位死亡原因trends in awareness, treatment, and control of hypertension in china awareness(%) treatment(%) control(%)中国心血管健康多中心合作研究高血压17etiologynthe pathogenesis of essential hypertension is multifactorial. ngenetic factors play an important r

8、ole. children with one- or two-hypertensive parents have higher blood pressures.nenvironmental factors also are significant. increased salt intake has long been incriminated as a pathogenic factor in essential hypertension. it alone is probably not sufficient to elevate blood pressure to abnormal le

9、vels; a combination of too much salt plus a genetic predisposition is required.高血压18etiology高血压19高血压20pathogenesisnsympathetic nervous system hyperactivity. it is most apparent in younger hypertensives, who may exhibit tachycardia and an elevated cardiac output. however, correlations between plasma

10、catecholamines and blood pressure are poor. 高血压21pathogenesisnrenin-angiotensin system. renin acts on angiotensinogen to cleave of the ten-amino-acid peptide angiotensin i. this peptide is then acted upon by angiotensin-converting enzyme to create the eight-amino-acid peptide angiotensin ii, a poten

11、t vasoconstrictor and a major stimulant of aldosterone release from the adrenal glands.高血压22pathogenesisndefect of natriuresis. hypertensive patients exhibit a diminished ability to excrete a sodium load. this defect may result in increased plasma volume and hypertension.高血压23pathogenesisnintracellu

12、lar sodium and calcium. an increase in intracellular na+ may lead to increased intracellular ca2 + concentrations as a result of facilitated exchange. this could explain the increase in vascular smooth muscle tone. 高血压24pathogenesisnexacerbating factors. the best-documented is obesity, which is asso

13、ciated with an increase in intravascular volume and an elevated cardiac output. some hypertensives respond to high salt intake with substantial blood pressure increases. excessive use of alcohol also raises blood pressure. cigarette smoking acutely raises blood pressure. 高血压25pathologynheart. left v

14、entricular hypertrophy may cause or facilitate many cardiac complications of hypertension, including congestive heart failure, ventricular arrhythmias, myocardial ischemia, and sudden death. 高血压26pathologynbrain. hypertension is the major predisposing cause of stroke, especially intracerebral hemorr

15、hage but also ischemic cerebral infarction. 高血压27pathologynkidney. chronic hypertension leads to nephrosclerosis, a common cause of renal insufficiency. 高血压28clinical findingssymptoms:nelevations in pressure are often intermittent early. even in established case, the blood pressure fluctuates widely

16、 in response to emotional stress and physical activity.高血压29clinical findingssymptoms:nmild to moderated essential hypertension is usually associated with normal health and well-being for many years. 高血压30clinical findingssymptoms:nsuboccipital pulsating headaches, but any type of headache, may occu

17、r. accelerated hypertension is associated with somnolence, confusion, palpitation. 高血压31signs：nhigh blood pressure.nphysical findings depend upon the duration and severity, and the degree of effect on target organs.na loud aortic second sound and an early systolic ejection click may occur. 高血压32cate

18、goryjnc 7（usa） european chinaoptimal120 and 80normal120 and 80120-129 and/or 80-84120 and 80high-normal120-139 or 80-89130-139 and/or 85-89120-139 or 80-89hypertension 140 or 90grade i140-159 or 90-99140-159 and/or 90-99140-159 or 90-99grade ii 160 or 100160-179 and/or 100-109160-179 or 100-109grade

19、 iii 180 and/or 110 180 or 110isolated systolic hypertension 140 and 90 140 and 30% 20-30% 15-20% 8% 5-8% 4-5% 4%高血压35factors influencing prognosis高血压36factors influencing prognosis高血压37management高血压38goals of treatment高血压39goals of treatment治疗组间的血压差异与卒中、治疗组间的血压差异与卒中、chd、主要、主要cvd事件、事件、cvd死亡及总死亡率风险的差

20、异直接相关死亡及总死亡率风险的差异直接相关lancet 2003;362:1527-450-5-10-15-20-25-30卒中chd心衰总死亡23%15%16%14% 4/3 mmhgn20 888主要cv事件15%高血压41managementlifestyle modificationnweight lossnsodium restrictionncalcium and potassium supplementationnhigh-fiber, low-fat dietnalcohol moderationnexercise高血压42when to initiate antihypert

21、ensive treatmentnbased on two criteria:nthe level of systolic and diastolic blood pressurenthe level of total cardiovascular risk高血压43initiation of antihypertensive treatment高血压44choice of antihypertensive drugsnfive major classes of antihypertensive agents thiazide diuretics, calcium antagonists, a

22、ce inhibitors, angiotensin receptor antagonists and -blockers are suitable for the initiation and maintenance of antihypertensive treatment, alone or in combination. 高血压45choice of antihypertensive drugs高血压46choice of antihypertensive drugs高血压47choice of antihypertensive drugs高血压48antihypertensive t

23、reatment: preferred drugs高血压49antihypertensive treatment: preferred drugs高血压50antihypertensive treatment: preferred drugs高血压51compelling and possible contraindications to use of antihypertensive drugs高血压52monotherapy versus combination therapynmonotherapy could be the initial treatment for a mild bp elevation with