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1、改善血压控制的质量和内涵,降低和控制清晨高血压 张维忠, 以长期高质量血压控制和预防或逆转靶器官损害为目标的优化治疗，更有利于指导降压治疗，并获得更大程度的益处。 优化治疗策略需要优选降压治疗的基本元素、剂量以及联合治疗方案与路径，2009年ESH治疗指南再评价提出 Preferred drugs，Preferred combinations。,降压治疗策略的新理念,Clinic BP can represent the whole blood pressure status ?,-20,-15,-10,-5,0,Drug A （highT/P ratio）,Drug B （low T/P r
2、atio）,Clinic BP Routine time of measurement,ABPM,Drug delivery,Neutel JM, Blood Pressure Monitoring 2001, 6: 9-16,Average BP change(mmHg),Dolan, E. et al. Hypertension 2005;46:15661,Superior predictive value of ABP on CV mortality,The Finn-Home Study,The Finn-Home Study .Hypertension 2012, 59:212-21
3、8,Prognostic Value of the Variability in Home-Measured Blood Pressure and Heart Rate,24-h Blood Pressure Profile,Time of day,Blood pressure (mm Hg),18:00 22:00 02:00 06:00 10:00 14:00 18:00,Time of awakening,Sleep,180,160,140,120,100,80,Millar-Craig et al, 1978; Mancia et al, 1983,清晨高血压 Morning Hype
4、rtension,清晨高血压: 清晨时段血压升高 (135/85 mmHg) 清晨高血压是隐蔽性高血压(Masked Hypertension) 的一种主要表现 清晨高血压与血压晨峰或血压昼夜节律异常 有密切关系,Cohen, MC, et al. Am J Cardiol 1997;79:1512-1516 Elliolt WJ Stroke 1998;29:992-996,CV Event is Highest In the Morning,*Relative risk (95% Cl) based on proportion of actual number of incidence v
5、ersus expected number of incidence (if no circadian variations existed),50,40,30,20,10,0,Acute Ml,Stroke,Increase in relative risk (%)*,38%,49%,Br J Cardiol 2008;15:31-34,High incident of Stroke & MI,清晨血压与心血管风险密切相关,Kario K, et al. Diabetes Care 2002;25:2218-2223.,Morning hypertension and complicatio
6、ns in Patients with type 2 diabetes,70,60,50,40,30,20,10,0,Morning normotensives (n=73) Morning hypertensives (n=97),p0.01,Prevalence of complications (%),Neuropathy,Retinopathy,Coronary Artery disease,Cerebrovascular disease,Hypertension status and diabetes on silent cerebral infarct,Eguchi K,et al
7、. Stroke 2003;34:2471-2474.,Morning hypertension and left ventricular hypertrophy In medicated patients with hypertensive,Data presented at the 2003 Annual Scientific Meeting of Japanese Society of Hypertension, Miyazaki, Japan.,White-coat hypertension (n=59),White-coat hypertension (morning surge),
8、Sustained hypertension (n=44),Morning hypertension (n=27),P=0.001,P=0.01,P=0.01,200,100,0,Left ventricular Mass index (g/m2),ME average (mmHg) 127.3 127.1 142.4 143.5 ME surge (mmHg) 8.4 24 7.3 25,Caramori ML, et al. N Engl J Med 2003; 348:260-264,160,140,120,100,80,40,60,80,100,120,Diastolic Pressu
9、re (mmHg),Systolic Pressure (mmHg),P=0.005,P=0.003,Morning,Daytime,Night-time,Morning,Daytime,Night-time,Microalbuminuria (n=14) Nonmoaibuminuria (n=17),NS,NS,NS,NS,Morning blood pressure and microalbuminuria In newly diagnosed diabetic patients,改善血压控制的质量和内涵,有效控制24小时血压水平 控制夜间高血压 控制清晨高血压 减轻长时血压变异,Blo
10、od pressure control in the risky early-morning hours,Redon J et al. Blood Press Monit 2002;7:111-118 Kario K et al. Circulation 2003;108:72e-73e,70,60,50,40,30,20,10,0,Controlled (morning SBP/DBP 135/85 mmHg),Not controlled,Patients (%),ACAMPA (ABPM),J-MORE (HBPM),Two studies in patients with contro
11、lled office BP have shown poor control of mean morning BP,控制清晨高血压的治疗方法,使用超长效降压药物 将给药时间改为临睡前 使用长效1阻滞剂多沙唑嗪控释片,苯磺酸氨氯地平长效的药理学机制, 氨氯地平的血浆半衰期长达35-50小时。 氨氯地平的分子侧链带正电荷，与带负 电荷的细胞膜结合，能持久地发挥阻滞 血管平滑肌细胞L型钙通道作用。,苯磺酸氨氯地平的化学结构和作用机制,苯磺酸氨氯地平的化学结构,氨氯地平与细胞膜的作用受电荷平衡影响,Morning dosing of amlodipine on morning BP in hypert
12、ensive patients,40,20,0,-20,-40,-60,-80,120,140,160,180,200,220,Baseline morning systolic BP (mmHg),4/35=11%,Amlodipine group Reduction of morning systolic BP (mmHg),r=-0.73 P0.001 n=38,Nonresponders,Eguchi K, et al. Am J Hypertens 2004;17:112-117,Morning dosing of valsartan on morning BP in hyperte
13、nsive patients,40,20,0,-20,-40,-60,-80,120,140,160,180,200,220,Baseline morning systolic BP (mmHg),15/33=45%,Valsartan group Reduction of morning systolic BP (mmHg),r=-0.53 p=0.001 n=38,Eguchi K, et al. Am J Hypertens 2004;17:112-117,Nonresponders,络活喜有效控制24h和清晨血压,Clin. Drug Invest. 1997;13(Suppl 1):67-72 AJH 1998;11:690696, 苯磺酸氨氯地平能长期有效平稳地控制外周和中心动脉的血压水平，阻止或减轻心、血管病变进展；降低短时和长时血压变异，控制清晨高血压，恢复血压正常昼夜节律,有助于减少触发心、脑血管病发生的机率。因此，苯磺酸氨氯地平是当代降压治疗优选的基本元素。,苯磺酸氨氯地平降压治疗优点,
