高血压联盟与转化医学刘力生课件

1、高血压联盟与转化医学刘力生高血压联盟高血压联盟与与转化医学转化医学 高血压联盟与转化医学刘力生Purpose of WHL To develop or promote health by educating and instructing health care professionals and the public on preventative and curative measures for hypertension. 对专业人员和群众进行对专业人员和群众进行 健康促进教育健康促进教育 To promote and conduct research related to the pr

2、evention and treatment of hypertension 促进和组织防治高血压的研究项目促进和组织防治高血压的研究项目 To promote the detection, control and prevention of hypertension in the population through joint efforts of all national leagues and societies. 联合各国的联盟与学会促进高血压防控工作联合各国的联盟与学会促进高血压防控工作 To liaise with the national bodies, promoting t

3、he exchange of information among them, and offering internationally applicable methods and programs for hypertension control. 与各国家团体联系,交流提供有关控制高血压的国际可行的方法与计划.高血压联盟与转化医学刘力生高血压联盟与转化医学刘力生高血压联盟与转化医学刘力生高血压联盟与转化医学刘力生高血压联盟与转化医学刘力生高血压联盟与转化医学刘力生高血压联盟与转化医学刘力生高血压联盟与转化医学刘力生高血压联盟与转化医学刘力生高血压联盟与转化医学刘力生转化医学与中国高血压联盟

4、转化医学与中国高血压联盟 转化医学是本世纪从循证医学发展而形成的一个医学实践转化医学是本世纪从循证医学发展而形成的一个医学实践和干预性流行病学的理念，它融汇基础科学、社会科学、和干预性流行病学的理念，它融汇基础科学、社会科学、政治科学于一体，兼顾治病和预防，其涵盖的领域已超出政治科学于一体，兼顾治病和预防，其涵盖的领域已超出现行医疗保健服务的范畴。现行医疗保健服务的范畴。 From bench to bedside to population(实验室实验室临床临床社区）社区） 转化医学研究可分为：转化医学研究可分为：1期：基础实验研究期：基础实验研究2期：基础研究应用于临床期：基础研究应用于临

5、床: 临床试验临床试验,中国高血压指南中国高血压指南3期：改变环境与政策层面的因素才能做到临床公共卫期：改变环境与政策层面的因素才能做到临床公共卫生和预防措施的可持续发展。生和预防措施的可持续发展。健康促进与社区防治健康促进与社区防治高血压联盟与转化医学刘力生 Hypertension Clinical Trials中国临床试验的经验 Liu Lisheng高血压联盟与转化医学刘力生Chronic Disease in China-2007 CVD Report of China中国慢病现状中国慢病现状New onset stroke: 2million/yr，Survived stroke:

6、13 millionCVD patients: 230 millionNew onset MI: 0.5 million，survived MI: 3 million；CHD: 8 milllionPatients with chronic diseases in 2003: 574 million ：DM:33 million-Cancer:46 millionCerebrovascular diseases: 93 millionCardiac disease: 165 millionHypertension:237 million高血压联盟与转化医学刘力生TrialsYear Contr

7、ibutionsSyst.-ChinaChinese Systolic HT in the Elderly Trial 1998Total mortality, CVD mortality & Stroke mortality reduced by CCB based treatment in isolated systolic HT ptsPATs Post Stroke Anti HT Treatment Study 1996 BP reduction in post stroke pts. Reduced stroke recurrence , even in normotens

8、ive STONE Antihypertensive tr.in elderlyCCB effective in stroke reduction in elder hypertensivesFEVERChinese Felodipine Event Reduction Trial2004 More or less antihypertensive treatment on stroke Hypertension Clinical Trials in China高血压联盟与转化医学刘力生TrialsYear ContributionsPROGRESSThe Perindopril Protec

9、tion Against Recurrent Stroke Study 2001Post stroke antihypertensive treatment effectively reduced the recurrence of stroke in patients suffered from strokeCREATEClinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation2005Post MI : use of reviparin is

10、beneficialADVANCEAction in diabetes & Vascular Disease: Preterax and Diamicaron Mr Controlled Evaluaton2006Antihypertensive tr. reduce the events of macro- and micro-vascular events in patients with DM (blood pressure arm)International Trials高血压联盟与转化医学刘力生TrialsYear Contributions & problemsWA

11、VE The Warfarin Antiplatelet Vascular Evaluation Study more hemorragic side effects in ChineseOASIS-6Organization for the Assessment of Strategies for Ischemic Syndromes-62006POISEEffects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery2008International Trials高血压联盟

12、与转化医学刘力生TrialsYear ContributionsONTARGET/TRANSEND Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint trial/Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with CVD2008RAS blocade treatment effectively reduce CVD events with either ACEI or ARB rather than bo

13、thHYVETThe Hypertension in the Very Elderly Tri 2008Antihypertensive treatment reduced major CVD events and mortality in very elderly (=80 yrs) hypertensive patientsInternational Trials高血压联盟与转化医学刘力生Experience (1/2)Easier to recruit participants from clinics or communities. Concommitant drug treatmen

14、t are less. large simple trials are feasible in China.高血压联盟与转化医学刘力生Example:Chinese subjects in HYVET(40% of total sample) Slightly younger, lighter & shorter. Smoked more but drank less alcohol. Less previous episodes of MI, more previous stroke Had lower blood urea, uric acid and Cr , higher HD

15、LC. Blood glucose & TC , Na & K, blood haematocrit & Hb were all lower. Much easier to recruit, less concomitant tr. More compliant to tr. Easier to FU.高血压联盟与转化医学刘力生Experience (2/2) CHL was established on top of Syst.-China & PATs Collaborative group (31 medical universities) in 1989

16、 & continuing on organizing RCTs both nationally & internationaly Established good relationship with world well known RCT Centers, implicating RCT results in Chinese population successfully. For ex. CCB based tr.used widely in ISH ,captopril in post MI after Syst-China and CCS1 trials.高血压联盟与

17、转化医学刘力生Translationalmedicineisatwo-waystreetDrivetocureshouldbecomplementedbygoingbackfrombedsidetolaboratorywithobservationsmadeinhumanstudies高血压联盟与转化医学刘力生Pharmacogenetics & individualized medicine WarfarindosageinAsianpeople Canfolicacidpreventstroke?ChinaStrokePrimaryPreventionTrial高血压联盟与转化医学

18、刘力生 Warfarin maintenance doses vary among different populations: Asians require lower doses EthnicityWarfarin doseReferencesAsianChinese3.3 (mg/day)Q. J. Med. 89,127-135Japanese3.3 (mg/day)Clin. Pharmacol. Ther. 63, 519-528CaucasianAmerican5.1 (mg/day)JAMA, 287, 1690-1698.Italian5.5 (mg/day)Blood, 1

19、05, 645-649.高血压联盟与转化医学刘力生“Certain single nucleotide polymorphisms in the VKORC1 gene (especially the -1639GA allele) have been associated with lower dose requirements for warfarin”. 高血压联盟与转化医学刘力生Description of current changes to the Crestor labelIn a pharmacokinetic study involving a diverse populat

20、ion of Asians residing in the United States, rosuvastatin drug levels were found to be elevated approximately 2-fold compared with a Caucasian control group. As a result of these findings, the “Dosage and Administration” section of the label now states that the 5 mg dose of Crestor should be conside

21、red as the start dose for Asian patients and any increase in dose should take into consideration the increased drug exposure in this patient population. Results of this pharmacokinetic study are further discussed under the “Clinical Pharmacology” and “Precautions” section of labeling.Ethnically Diff

22、erent Dose Recommendation高血压联盟与转化医学刘力生Pharmacogenetics & individualized medicine WarfarindosageinRCT(wavestudy) Canfolicacidpreventstroke?ChinaStrokePrimaryPreventionTrial高血压联盟与转化医学刘力生中国高血压指南中国高血压指南高血压联盟与转化医学刘力生项目设计项目设计 开放性、多中心的横断面观察性登记研究横断面观察性登记研究，入组已接受降压药物治疗的门诊高血压患者 全国城市三甲医院涉及纳入高血压患者 以下问题为本研究关

23、注重点：- 患者的人口学特征- 患者的血压控制情况- 患者的心血管危险因素及相关实验室检查结果- 患者的降压药物应用情况- 患者的关于高血压治疗的认知状况的调查高血压联盟与转化医学刘力生Survey of hyperTensive pAtienTs blood pressUre control rate in clinic Service联合发起并主办高血压联盟与转化医学刘力生总结总结三甲医院三甲医院心血管科、肾内科、内分泌科心血管科、肾内科、内分泌科门诊高血压患者门诊高血压患者血压140/90mmHg达标率为45.1%糖尿病或肾病患者血压(130/80mmHg)和其他患者（140/90mmH

24、g）血压达标率为31.1%最常见的合并疾病依次为血脂异常(43.2%)、糖尿病(37.1%)、冠心病(22.6%)及肾功能不全(18.3%)高血压联盟与转化医学刘力生68.9%1992-1994199820022009BP未达标未达标BP达标达标已接受治疗的高血压患者中血压已接受治疗的高血压患者中血压140/90mmHg不断提高！不断提高！2006年中国心血管病报告0%20%40%60%80%100%87.3%80.1%75%54.9%12.7%19.9%25.0%87.3%80.1%75%54.9%12.7%19.9%25.0%45.1%68.9%31.1%31.1%45.1%CHINA STATUS数据高血压联盟与转化医学刘力生引发的思考引发的思考 但我们仍然面临挑战 31.1%的