高血压合并动脉硬化的研究现状治疗及展望李玉明课件

1、Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明u脑卒中（54%）缺血性心脏病（47%） u我国高血压患病率：男性20%，女性17%； Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明AwarenessTreatmentControl0102030menwomenPrevalence (%)22%25%16%20% 4%5% 01020304050607080AwarenessTreatmentControlNHANES II1

2、976 1980NHANES III(phase 2)1991 1994NHANES1999 2004NHANES III(phase 1)1988 199151%31%10%73%55%29%68%54%27%72%61%35%Prevalence (%)Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明MenSystolic pressureDiastolic pressure150140130120110100908070018-2930-3940-4950-5960-6970-7980Age(year)Blood pressure(mmHg)Wom

3、enSystolic pressureDiastolic pressure15014013012011010090807018-2930-3940-4950-5960-6970-79800HispanicNon-Hispanic whiteNon-Hispanic blackAge(year)Blood pressure(mmHg)N Engl J Med 2007;357:789-96.Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明4040-4950-5960-6970-7980020406080100Isolated systolic hypert

4、ensionSystolic-diastolic hypertensionIsolated diastolic hypertensionAge(year)Frequency(%)N Engl J Med 2007;357:789-96.Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明10011012013014015030 Systolic Blood Pressure (mmHg)Body Mass Index(Kg/m2)Circulation 2008;118:2679-2686.Cardiovascular Disease高血压合并动脉硬化的研究

5、现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Endothelial Cell:Endothelial dysfunctionIncreased permeabilityIntima:collagen, Macrophage, Leukocytes, I-CAM, MMP,TGF-, VSMCElastinMedia:VSMC, collagen, MMPsElastinAdventita:Collagen fibroblastsExtrinsi

6、c Influences: NaCl, lipids, angiotensin, sympathetic Neurohormones, shear stress, increased luminal diameterCardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Mechanical Strain-induced: Elastin Fragmentation Collagen Deposition Medial calcificationAcceleratorsAor

7、tic stiffeningIncreased pulse wave velocityHypertension IGT/DiabetesRenal Disease SmokingVascular Cell SenescenceAortic Dilatation Wall HypertrophyEndothelial Dysfunction: Reactive species Oxidized LDL Angiotensin IIAdvanced Glycation (AGEs):Impaired glucose toleranceModification of collagen Cardiov

8、ascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明 t LCommoncarotidarteryCommonfemoralarteryCardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明C

9、ardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Peak systolic pressureEnd diastolic pressureTime: period of the heart cycleinflectionpoint:arrivalof the reflected waveTrAPCardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明youngmiddleoldoldmiddleyoungRADIALAORTAJ Am Coll Cardiol 2007;50:113Cardiovascular Disease

10、高血压合并动脉硬化的研究现状治疗及展望李玉明J Am Coll Cardiol 2007;50:113YOUNG016080100120140time(s)mmHgYOUNG016080100120140time(s)mmHgOLD016080100120140mmHgOLD016080100120140mmHgRADIALAORTACardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明

11、Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明 Eur Heart J.2006.27:2588-2605.Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明N Engl J Med 2007;357:789-96.Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明2007 Guidelines for the management of arterial hypertension. Eur Heart J. 2007;28:1462-1536 Cardiovascular D

12、isease高血压合并动脉硬化的研究现状治疗及展望李玉明； 。（Ann Intern Med.2002.136:438-448）Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明0123457090110130150170190Active-treatment groupPlacebo group0Systolic blood pressureDiastolic blood pressureNo. at riskPlacebo group1912 1468 701 33

13、0 191 116Active-treatment group1933 1540 754 373 207 118YearsBlood Pressure(mm Hg)N Engl J Med.2008.358:1887-1898.Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明012340.01.02.03.04.05.06.07.08.0P=0.06Placebo groupActive-treatmentgroupFatal or Nonfatal StrokeNo. at riskPlacebo group 1912 1484 807 374 194

14、Active-treatment group 1933 1557 873 417 229Follow-up (yr)No.of Events per 100 patientsN Engl J Med.2008.358:1887-1898.Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明012340102030Placebo group Active- treatment groupP=0.02Death From Any Cause Follow-up(yr)No. of Events per 100 patientsN Engl J Med.2008.

15、358:1887-1898.0123402468Follow-up (yr)P0.001Placebo group Active-treatment groupHeart FaliueNo. of Events per 100 patientsCardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明Am J Physiol Renal Physiol.2009.297:F237-243.Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明0

16、204060800500100015002000Age(years)PWV(cm/second)J Am Coll Cardiol 2007;50:113Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明全球食盐摄入量地区分布Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明l Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明低钠代用盐的降压研究中国代用盐研究Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明低钠代用盐的降压研究复合离子盐%9

17、965%/30%0.50.1%/0.8%0.50.1mg/Kg/4mg/Kg0.50.1mg/Kg1.00.3mg/Kg205025mg/Kg/12Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明低钠代用盐的降压研究复合离子盐Am J Hypertens 2009; 22:934-942 Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明第三部分 低钠复合离子盐研究Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明第三部分 低钠复合离子盐研究Cardiovascular Dise

18、ase高血压合并动脉硬化的研究现状治疗及展望李玉明低钠代用盐的降压研究复合离子盐*baselinemonth 2month 4month 601060708090100Normal SaltCompound Ion Salt74.976.474.173.777.773.276.371.6Time after RandomizationPulse Pressure (mmHg)Am J Hypertens 2009; 22:934-942 Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明低钠代用盐的降压研究复合离子盐Cardiovascular Disease高血压合并动脉硬化的研究现状治疗及展望李玉明低钠代用盐的降压研究复合离子盐Cardi