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 Purpose of WHLTo 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健康促进教育To promote and conduct research related to the prevention and treatment of hypertension促进和组织防治高血压的研究项

2、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To liaise with the national bodies, promoting the exchange of information among them, and offering internationally applicable methods and

3、 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.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现行医疗保健服务的范畴。 From bench to bedside to population(实验室临床社区）转化医学研究可分为：1期：基础实验研究2期：基础研究应用于临床: 临床试验,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生和预防措施的可持续发展。健康促进与社区

4、防治TrialsYear ContributionsPROGRESSThe Perindopril Protection 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 Infarctio

5、n Treatment Evaluation2005Post MI : use of reviparin is 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 TrialsTr

6、ialsYear Contributions & problemsWAVE 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 s

7、urgery2008International TrialsTrialsYear 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

8、 or ARB rather than bothHYVETThe Hypertension in the Very Elderly Tri 2008Antihypertensive treatment reduced major CVD events and mortality in very elderly (=80 yrs) hypertensive patientsInternational TrialsExperience (1/2)Easier to recruit participants from clinics or communities. Concommitant drug

9、 treatment are less. large simple trials are feasible in China.Experience (2/2)CHL was established on top of Syst.-China & PATs Collaborative group (31 medical universities) in 1989 & continuing on organizing RCTs both nationally & internationalyEstablished good relationship with world well known RC

10、T 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.Translational medicine is a two-way streetDrive to cure should be complemented by going back from bedside to laboratory with observatio

11、ns made in human studiesPharmacogenetics & individualized medicineWarfarin dosage in Asian peopleCan folic acid prevent stroke ? China Stroke Primary Prevention Trial Warfarin maintenance doses vary among different populations: Asians require lower doses EthnicityWarfarin doseReferencesAsianChinese3

12、.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, 105, 645-649.“Certain single nucleotide polymorphisms in the VKORC1 gene (especially the -1639GA allele) have been associated with lower d

13、ose requirements for warfarin”. Description of current changes to the Crestor labelIn a pharmacokinetic study involving a diverse population 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

14、result of these findings, the “Dosage and Administration” section of the label now states that the 5 mg dose of Crestor should be considered 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

15、 this pharmacokinetic study are further discussed under the “Clinical Pharmacology” and “Precautions” section of labeling.Ethnically Different Dose RecommendationPharmacogenetics & individualized medicineWarfarin dosage in RCT (wave study)Can folic acid prevent stroke ? China Stroke Primary Preventi

16、on Trial中国高血压指南项目设计开放性、多中心的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22个城市，100家三甲医院涉及心血管科、肾内科、内分泌科纳入5000例高血压患者以下问题为本研究关注重点：- 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Survey of hyperTensive pAtienTs blood pressUre control rate in clinic Service两大权威机构联合发起并主办总结三甲医院心血管科、肾内科、内分泌科门诊

17、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（140/90mmHg）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%)68.9%1992-1994199820022009BP未达标BP达标已接受治疗的高血压患者中血压140/90mmHg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%6

18、8.9%31.1%31.1%45.1%CHINA STATUS数据引发的思考 但我们仍然面临挑战31.1%的达标率对我们是否已经足够好?多数高血压患者合并其他疾病，降压需要更关注器官的保护60%的患者从不漏服降压药物，而总体达标率31.1%，( 140/90mmHg为45.1%)提示我们是否应该选择更强更有效的治疗方案，以使血压尽早达标。 我们仍要为提高我国高血压患者的知晓率，治疗率和达标率、继续努力！继续教育与宣传群众可持续发展的社区防治Epidemiological report from ChinaDATA FROM 5- AND 10 YEAR FOLLOW-UP SURVEYS OF 10,450 WORKERS本文刊登于Mild Hypertension Recent Advances1983年Pilot Trial ExperienceOrganization is guarantee -Arrange at every levelZhejiang provinceStress