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1、高血壓的預防與控制高血壓程度上之分類18歲以上之成人收縮壓及舒張壓 血壓分類 收縮壓 舒張壓 理想血壓 160 100 獨立收縮性高血壓 140-149 135/85 and during sleep 120/75 BP drop 10 to 20% at night if not signspossible increase risk of CVD張孟源內科診所斜塔JNC7的新遠景和新資訊 任何一個50歲以上的個人其收縮壓的控制 比舒張壓更為重要 在55歲時為正常血壓的人其一生中有90% 的機率產生高血壓。張孟源內科診所心血管疾病的盛行率CVD account for 30% of deat
2、h world wildCVD leading cause of deaths in developed countriesBy 2020 CVD will become #1 killer in developed Countries/economies in transition張孟源內科診所心血管疾病的盛行率 36 out of 100 people will die of CVD in 2020Cause 1990 1999 2020million(%) million(%) million(%) 冠狀動脈疾病 6.2 (12.4%) 7.1(12.7%) 11.1(16.2%)腦中風
3、 4.3(8.5%) 5.5(9.9%) 7.7 (11.3%)其他血管疾病 2.6(5.1%) 4.3 (7.7%) 6.0 (8.8%)所有血管疾病 13.1(26%) 16.9(30.3%) 24.8(36.3%)WHO 張孟源內科診所Causes of Hypertension Essential hypertension Chronic renal disease, renovascular dx Primary hyperaldosteronism Pheochromocytoma ,cushing syndrome Sleep apnea Drug induced and chr
4、onic steroid user Thyroid or parathyroid disease張孟源內科診所代謝性症候群：大流行的反擊.全球現代化的改變糖尿病和CVD 危險因子糖尿病 高血壓高罹患率與死亡率高社經地位代謝性症候群： 遺傳因子與環境的交互作用. 環境因素Early Life Adult Life 出生你體重不足 做是生活型態 營養不足 飲食因素代謝性症候群心血管疾病基因高血壓是否屬於代謝性症候群？造成高血壓因素： 肥胖 胰島素抗性 遺傳 老化 飲食因素 高血壓是否為一代謝性危險份子？ 高血壓前期是否亦計算成危險份子？中央肥胖與代謝異常中央肥胖與代謝異常動脈硬化 血脂異常胰島素抗
5、性血栓栓塞發炎反應Primary prevention1 Primary prevention of HTN may improvequality of life and costs associated with medical management and its complication 2.In those higher than optimal120/80mmHgdecrease 3 mmHg decrease 8% stroke5% CVD risk 3.Individuals at highest risk should bestrongly encouraged to adap
6、t healthy life張孟源內科診所Pre-hypertension stage Pre-hypertension signals the need forIncrease education to reduce BP in orderto prevent hypertensionPre-hypertension are at increased risk forProgression to hypertension at double risk張孟源內科診所JNC7的新遠景和新資訊 即使收縮壓在120-139之間舒張壓在80-89 之間，仍是為高血壓前期，必須改善健康 的生活型態，以避
7、免高血壓的產生。 自從115/75mmHg以上每增加20/10mmHg 心血管得危險性倍增。張孟源內科診所Benefits of Lowering BPAverage percent reduction Stroke incidence 35-40% Myocardial infarction 20-25% Heart failure 50%張孟源內科診所Benefits of Lowering BPIn stage I hypertension and additional CVD Risk factors, achieving a sustained 12mmHg Reduction in
8、 SBP over 10 yrs will prevent 1 death for 11 patients Each increment of 20/10mmHg double the Risk of CVD across the entire BP range Starting from 115/75 張孟源內科診所高血壓治療原則 血壓必須控制在理想範圍SBP 50years of age 張孟源內科診所高血壓控制比率全國健康評估報告美1976-1986 1988-1991 1991-1994 1999-2000Awareness 51 73 68 70Treatment 31 55 54
9、59Control 10 29 27 34張孟源內科診所JNC7的新遠景和新資訊 最有效的治療方式，必須由主動積極的高 血壓患者，與具有專業及愛心的醫師互相 配合。 醫病關係是建立在，同理心，互相協商彼此了解。 正向的互動，與良好醫病關係，奠定治療成功的基礎。張孟源內科診所 Follow-up and Monitor Patient should returned for follow-up andadjustment of medications until BP goal is reached More frequent visits for stage II HTN andcomplic
10、ated comorbid condition Serum potassium and creatinine monitor張孟源內科診所Hypertension in older person More than two-third of people with 65with HTN This population has the lowest rate of BPcontrol Treatment including isolated systolic HTN Lower initial drug dose and then standarddose will be needed to r
11、each BP target張孟源內科診所Hypertension in Women Oral contraceptives may increase BP andBP should check regularly ,in contrast HRT Dose not raise BP Pregnant women with HTN should beFollowed carefully ,BB and vasodilator張孟源內科診所Left ventricular hypertrophy LVH is an independent risk factor that increases t
12、he risk of CVD Regression of LVH with aggressive BPMeasurement and weight loss, exercisesodium restriction and medication control張孟源內科診所Peripheral Arterial Disease PAD is equivalence in risk to ischemicHeart disease Other risk factor should be managedaggressively ,aspirin should be used.張孟源內科診所Demen
13、tia Dementia and cognitive impairment occurred more commonly in people withhypertension Reduced progression of cognitive impairment occurs with effectiveantihypertensive therapy張孟源內科診所Target Organ Damage Heart : LVH ,angina .coronary revascularization, heart failure Brain : stroke ,transient ischemi
14、c attack Chronic kidney disease Peripheral vascular disease Retinopathy 張孟源內科診所Hypertensive urgencies and emergencies Patients with marked BP elevations and acute TOD ( encephalopathy ,myocardialinfarction unstable angina ,pulmonary edema, eclampsia .stroke ,head trauma Aortic dissection required hospitalization張孟源內科診所Hypertensive urgencies and emergenciesPatient with marked elevated BP withoutTOD should immediately antihypertensivedrug. 張孟源內科診所Postural hypotension Decrease
