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1、What Is Hypertension?,JNC 7 Definitions,Chobanian AV, et al. Hypertension 2003;42:1206-52,*Individuals aged 40-69 years, starting at blood pressure 115/75 mm Hg. CV, cardiovascular; DBP, diastolic blood pressure; SBP, systolic blood pressure. Chobanian AV et al. JAMA. 2003;289(19):2560-2572. Lewingt
2、on S et al. Lancet. 2002;360(9349):1903-1913.,Cardiovascular Mortality Risk Doubles With Each 20-mm Hg SBP or 10-mmHg DBP Increment*,Cardiovascular mortality risk,2x,4x,8x,Non-Hispanic White,Non-Hispanic Black,Mexican American,Men (age, years),Hypertension* Prevalence (%),0,20,40,60,80,100,Women (ag
3、e, years),0,20,40,60,80,100,Hypertension* Prevalence (%),*Hypertension defined as a BP of 140/90 mm Hg or reported use of antihypertensives. Error bars indicate 95% confidence intervals. Data are weighted to the US population. Hajjar I, Kotchen TA. JAMA. 2003;290:199-206.,Prevalence of Hypertension
4、Increases with Age: NHANES 1999-2000 Data,NHANES = National Health and Nutrition Examination Survey. Fields, LE et al. Hypertension. 2004;44:398-404.,Increasing Prevalence of Hypertension: Rise From 1988 to 2000 (NHANES),0,0.5,1,1.5,2,2.5,3,3.5,4,4.5,5,Non-Hispanic Whites,Non-Hispanic Blacks,Mexican
5、 Americans,% Increase (19881994 to 19992000),Ethnic/Racial Differences in Prevalence of Hypertension,Blacks have a higher prevalence and incidence of hypertension than whites. Most studies in the United Kingdom and the United States report a higher prevalence and lower awareness of hypertension in b
6、lack people than in white people. In Mexican-Americans, the prevalence and incidence of hypertension is similar to or lower than in whites. NHANES III reported an age-adjusted prevalence of hypertension at 20.6% in Mexican-Americans and 23.3% in non-Hispanic whites.,Group HTN Prevalence White 21.2%
7、Black/African-American 29.2% Hispanic/Latino 19.6% Asians 16.9% Native Hawaiian/other Pacific Islander 20.7% American Indians/Alaska Natives 25.4%,American Heart Association Heart Disease and Stroke Statistics 2007,Hypertension Prevalence by Ethnic/Minority Groups,Contributing Factors: Social, Envir
8、onmental, or Genetic?,Environmental factors ultimately related to race (e.g. socioeconomic disadvantage, less access to health care) play roles in causing and sustaining hypertension 1, 2 Despite similar African heritage, Africans living in Africa or West Indies have much less hypertension than Afri
9、can Americans 3,4In rural Africa, hypertension prevalence is very low and blood pressure does not rise with age as it does in all ethnic groups in US 3,1 Cooper RS, Rotimi CN, Ward R. The puzzle of hypertension in African-Americans. Sci Am. 1999;280:5662. 2 Geronimus AT, Bound J, Waidmann TA, et al.
10、 Excess mortality among blacks and whites in the United States. N Engl J Med. 1996;335(21):15521558. 3 Cooper R, Rotimi C, Ataman S, et al. The prevalence of hypertension in seven populations of west African origin. Am J Public Health. 1997;87:160168. 4 Ordunez-Garcia PO, Espinosa-Brito AD, Cooper R
11、S, et al. Hypertension in Cuba: evidence of a narrow black-white difference. J Hum Hypertens. 1998;12:111116.,BP Reductions as Small as 2 mm Hg Reduce Risk of CV Events by Up to 10%,Meta-analysis of 61 prospective, observational studies 1 million adults 12.7 million person-years,Prospective Studies
12、Collaboration. Lancet. 2002;360:1903-1913.,2 mm Hg decrease in mean SBP,10% reduction in risk of stroke mortality,7% reduction in risk of CHD mortality,BPLTTC Meta-analysis: Stroke and CHD,Blood Pressure Lowering Treatment Trialists Collaboration. Lancet. 2003;362:1527-1535.,JNC7 Algorithm for Treat
13、ment of Hypertension,Not at Goal BP 140/90 mm Hg for most 130/80 for those with diabetes or CKD,Initial Drug Choices,Drug(s) for compelling indications + BP meds as needed,Compelling Indications,Lifestyle Modifications,Stage 2 BP 160/1002-drug combo for most (diuretic + ACEI, or ARB, or BB, or CCB),
14、Stage 1 140-159/90-99 Diuretics for most; consider ACEI, ARB, B, CCB,No Compelling Indications,Not at Goal BP,Optimize dosages or add drugs until goal BP is achieved. Consider hypertension specialist consult.,Chobanian AV, et al. JAMA. 2003;289:2560-2572.,ACEI = ACE inhibitor CCB = calcium channel b
15、locker ARB = angiotensin receptor blocker B = -blocker CKD = chronic kidney disease,JNC 7 Compelling Indications,Chobanian AV, et al. JAMA. 2003;289:2560-2572.,Heart failure Post-MI High CHD risk Diabetes Chronic kidney disease Recurrent stroke prevention, , ,B, ,ACEI, ,ARB, ,CCB, ,AA,Diuretic,AA = aldosterone antagonist,AHA Perspective/Hypertension Management and BP Goals Summary of Main Recommendations,
