老年高血压患者的治疗课件

1、老年高血压患者的治疗ACC in ChinaHypertension, Prevention and Lipids (HPL) Jiguang WANG, MD, PhDShanghai Institute of Hypertension, Ruijin Hospital, Shanghai, China老年高血压患者的治疗Management of hypertension in the elderly Jiguang WANG, MD, PhDShanghai Institute of Hypertension, Ruijin Hospital, Shanghai, China老年高血压患

2、者的治疗nSize of the problem: hypertensionnCareful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harmnRoadmap to control blood pressure in resistant hypertensive patients老年高血压患者的治疗Awareness, treatment and control rates of hypertension in ChinaPrevalenceNum

3、ber of patientsAwareness TreatedControlled 1991 (15 y)11.394 million26.645.5% (12.1)23.1% (2.8)2002 (18 y）18.8160 million30.281.8% (24.7)25.0% (6.1)2002 (60 y）49.170 million37.696.3% (36.2)24.1% (7.6)Chin J Hypertens 1995;3(suppl):14 -18; Li Liming, et al. ChinJ E pidemiol 2005;26:,478-484.老年高血压患者的治

4、疗nSize of the problem: hypertensionnCareful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harmnRoadmap to control blood pressure in resistant hypertensive patients老年高血压患者的治疗Relative risk reductions by antihypertensive treatment in early trialsProgressi

5、on to severe HTCHFStrokeCHDTotal mortalityCV mortality-94*-53%*-40%*-16%*-13%-21%*P0.05Collins R et al. Br Med Bull 1994;50:272-298.老年高血压患者的治疗BPLTTC. Lancet 2003;362:1527-45.0-5-10-15-20-25-30StrokeCHDCHFTotal mortality -23%-15%-16%-14%4/3 mmHgN20 888Major CV events -15%Relative risk reductions by a

6、ntihypertensive treatment in recent trials老年高血压患者的治疗指南推荐指南推荐o利尿剂利尿剂o 阻滞剂阻滞剂o钙离子拮抗剂钙离子拮抗剂o转换酶抑制剂转换酶抑制剂o血管紧张素受体拮抗剂血管紧张素受体拮抗剂J Hypertens 2007;25:1105-87.老年高血压患者的治疗INTERMAP: Urinary electrolytes in menZhou BF et al. J Hum Hypertens 2003;17:623630. JapanChinaUKUSAUrinary Na(mg/day)4843563337024202Urinary

7、 Na(mmol/day)211245161183Urinary K(mg/day)1920150629122512Urinary K(mmol/day)49.238.674.764.4Urinary Na/K(mmol/mmol)4.56.82.33.1老年高血压患者的治疗INTERMAP: Urinary electrolytes in womenZhou BF et al. J Hum Hypertens 2003;17:623630.JapanChinaUKUSAUrinary Na(mg/day)4278483929293272Urinary Na(mmol/day)18621012

8、7142Urinary K(mg/day)1891147523781982Urinary K(mmol/day)48.537.961.050.8Urinary Na/K(mmol/mmol)4.16.02.23.1老年高血压患者的治疗HYVET: Serum concentrations of cholesterol, sodium and potassiumLiu LS et al. Chin Med J 2008; 121:1509-1512.MenWomen Characteristic (mmol/L)China Other countriesChina Other countries

9、 Total cholesterol4.691.05.451.15.021.15.601.1HDL cholesterol 1.370.36 1.290.391.430.361.330.43Sodium 1404.1 1424.11404.1 1424.3Potassium 4.250.47 4.420.404.260.494.380.40老年高血压患者的治疗SHEP: New-onset diabetes mellitusShafi T et al. Hypertension 2008;52:1022-9.45% per 0.5 mmol/L in K+老年高血压患者的治疗nSize of

10、the problem: hypertensionnCareful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harmnRoadmap to control blood pressure in resistant hypertensive patients老年高血压患者的治疗Hypertension 2008老年高血压患者的治疗Pharmacologic recommendations for the treatment of resistant h

11、ypertension (1) Use of a long-acting thiazide diuretic, preferably chlorthalidone Combine agents with different mechanisms of action Recommended triple regimen of - ACE inhibitor or ARB - Calcium channel blocker- Thiazide diuretic老年高血压患者的治疗oConsider addition of mineralocorticoid receptor antagonist.

12、 oUse of loop diuretic may be necessary in patients with CKD (creatinine clearance 30 mL/min). Pharmacologic recommendations for the treatment of resistant hypertension (2)老年高血压患者的治疗Number No. drugs 2 drugsALLHAT42,4241.840%ANBP26083 2.050%ASCOT19,2572.378%CONVINCE16,6021.840%INVEST22,5763.085%LIFE9

13、1932.046%VALUE15,2452.054%Number of drugs in recent large HT trialsAchieved 135/76147/82136/77136/79131/76144/81138/78老年高血压患者的治疗Catheter-Based Renal Sympathetic Denervationfor the Management of Resistant HypertensionHenry Krum MBBS PhD FRACPCentre of Cardiovascular Research & Education in Therapeuti

14、cs, Monash University/Alfred Hospital;Alfred Heart Centre, The Alfred Hospital, Melbourne, Australia老年高血压患者的治疗Treatments 老年高血压患者的治疗Catheter-Based Renal Sympathetic Denervationfor the Management of Resistant HypertensionHenry Krum MBBS PhD FRACPCentre of Cardiovascular Research & Education in Therape

15、utics, Monash University/Alfred Hospital;Alfred Heart Centre, The Alfred Hospital, Melbourne, Australia老年高血压患者的治疗Results: Blood Pressure Reduction 87% had a reductionin SBP 10 mmHgP0.001 except for DBP at 12 months (P=0.02)老年高血压患者的治疗Conclusions Therapeutic renal sympathetic denervation produced pred

16、ictable, significant, and sustained reductions in BP in patients with resistant hypertension. The brief and simple procedure was performed without significant complications to either the renal artery or the kidney. Results appear both to confirm the important role of renal sympathetic nerves in resi

17、stant hypertension and to suggest that renal sympathetic denervation could be of therapeutic benefit in this patient population. Prospective randomized clinical trials examining the treatment of hypertension are beginning in 2009, and trials in heart failure and chronic kidney disease are anticipate

18、d. 老年高血压患者的治疗n因为知晓率低、用药后血压控制率低，我国因为知晓率低、用药后血压控制率低，我国90%以上的高血压患以上的高血压患者的血压未得到有效控制者的血压未得到有效控制(140/90 mm Hg)，在广大农村该比例，在广大农村该比例甚至高达甚至高达96.5%。因此，必需大幅度提高高血压检出率与治疗控。因此，必需大幅度提高高血压检出率与治疗控制率。制率。n指南推荐使用的指南推荐使用的5大类降压药物均可在大类降压药物均可在50%以上的患者中发挥降以上的患者中发挥降压作用。在关注降压达标的同时，应尽可能减少降压药物的不良压作用。在关注降压达标的同时，应尽可能减少降压药物的不良反应，降低降压治疗的代价。反应，降低降压治疗的代价。n联合降压治疗，特别联合使用联合降