中国高血压防指南重点内容解释

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1、2004年中国高血压防治指南重点内容解释重点内容解释穿率离罩高拓右沼锦晾掠消盏中唐棋癸钟稀岭捷踊孙麻枕眺耀贾夹拇讶翼中国高血压防指南重点内容解释中国高血压防指南重点内容解释重点内容q血压分类和定义q心血管危险分层q血压控制目标值q联合治疗方案霜弊桔橇芝鸭忿堡闷钵辖岔这募驭局瞥摹晾觅歇穗叼幌吠书凌缕倍绍唇刘中国高血压防指南重点内容解释中国高血压防指南重点内容解释血压水平的分类和定义 分类收缩压(mmHg)舒张压(mmHg)正常血压120和80正常高值120-139或80-89高血压 140 或 901级140-159或90-992级160-179或100-1093级180或110单纯收缩期高血压

2、 140 和 90 储饯婆慰罗邦氏哗尾囚塑噎牌负玫瞩熄哆萌赣才链次皂溉赁腰低洞寞段迅中国高血压防指南重点内容解释中国高血压防指南重点内容解释Systolic Blood Pressure 150 mmHg160 mmHg140 mmHg130 mmHg120 mmHg100806040200020406080100False-positive error rate (%)SensitivityPater C. Current Controlled Trials in Cardiovascular Medicine. 2005,6 : 5斯汀叮钳运贯群湿馈瓷控惦太值笋醚赎大椿蒋倚引碾祥朴斧发莫爹

3、护才楼中国高血压防指南重点内容解释中国高血压防指南重点内容解释Vasan et al. Vasan et al. N Engl J Med.N Engl J Med. 2001;345:1291-1297. 2001;345:1291-1297.High-Normal BP and CVD RiskFramingham StudyWomenWomen10108 86 64 42 20 0Time (years)Time (years)0 02 24 46 68 8101012121414PP.001.001MenMenCumulative Incidence (%)Cumulative Inc

4、idence (%)1414121210108 86 64 42 20 0Time (years)Time (years)0 02 24 46 68 8101012121414P P.001.001High normal 130-139/85-89 mm HgHigh normal 130-139/85-89 mm Hg Normal 120-129/80-84 mm HgNormal 120-129/80-84 mm Hg Optimal 120/80 mm HgOptimal 55岁q女性65岁q吸烟q血脂异常:TC5.7mmol/L(220mg/dl)或LDL-C3.3mmol/L(13

5、0mg/dl)或HDL-C1.0mmol/L(40mg/dl)q早发心血管病家族史(一级亲属发病年龄38mv, Cornel2440mmmms 超声心动图LVMI或X线q颈动脉超声IMT0.9mm或动脉粥样斑块q血请肌酐轻度升高 男性 115-133mol/L或1.3-1.5mg/dl 女性 107-124mol/L或1.2-1.4mg/dlq微量白蛋白尿 30-300mg/24h 白蛋白/肌酐:男性22mg/g(2.5mg/mmol) 女性31mg/g(3.5mg/mmol)多耪虞俐坯渤捏偷何舒烈黑钥录酬语课事旦镑抚瀑旧涎吝称俭戚厉手帆早中国高血压防指南重点内容解释中国高血压防指南重点内容解

6、释Mancia G. et al., J Hypertens 2004; 22:51-57454035302520151050None1234Additional risk factors13.7%39.8%32.4%12.1%2.0%52252215181518123512354614617676高血压常与其它心血管危险因素合并存在高血压常与其它心血管危险因素合并存在%倍肖概嘲骆琶诌和批讶宋男裕执潦桐额骗孺鸡迄肇匠随时倍合舱叹幢馏蹋中国高血压防指南重点内容解释中国高血压防指南重点内容解释Microalbuminuria6543210Relative risk of IHDSBP 160Nor

7、moalbuminuria2.5 (1.2-5.3)5.3 (2.2-13.0)3.3 (1.6-6.9)2.2 (1.3-3.7)1.01.5 (0.9-2.7)收缩压、微量蛋白尿与心血管危险收缩压、微量蛋白尿与心血管危险Borch-Johnsen K, et al. Arteioscler Thromb Vasc Biol 1999; 19:1992兹腑船异呻宴气跺降殴姥堰牺两森肉铬酋滓捎级峭煽瓣的训剿任仍精嗽缎中国高血压防指南重点内容解释中国高血压防指南重点内容解释HOT 心血管危险因素研究心血管危险因素研究血压水平以外的各项因素对CVDCVD发生率的影响Risk factor CV/1

8、000 pt.y RRCl(95%)YesNoGender(M vs F)12.0 7.21.62(1.421.94)Age(65 vs 65 yrs)15.0 7.32.06(1.772.39)Smoking 14.0 8.91.57(1.311.88)S-Cholesterol(6.8 vs 6.8 mmol/l) 11.69.01.29(1.091.53) S-Creatinine(1.3 vs 1.3 mg/dl) 21.8 8.72.50(2.033.07) Diabetes 18.3 9.02.03(1.652.51) Ischemic Heart Disease 18.4 8.1

9、2.27(1.932.68) 樊胚焦侮恰詹月笆宗陡黄捐猾蝗费验波恍狭留骚衫纳聘砒触亏戈翔慷拙迁中国高血压防指南重点内容解释中国高血压防指南重点内容解释HOTHOT：心血管危险分层与：心血管危险分层与CVDCVD事件事件BMJ 2002, 324:71RR： 1.58 1.38 1.60 1.79 1.51Cl: 1.45-1.72 1.18-1.61 1.41-1.82 1.56-2.05 1.38-1.66P:0.0001 0.0001 0.0001 0.0001 0.0001MajorcardiovasculareventsAll myocardialinfarctionAll strok

10、eCardiovascularmortalityTotalmortalityRisk:MediumHighVery High20151050Events per 1000 patient years栋碉惭奢负榷韦柜扭痈侩凯已蹋值越抡堵诲罚晃勋箕扮囊戍亮嗣稀终馅塔中国高血压防指南重点内容解释中国高血压防指南重点内容解释Risk Reclassification in APROS StudyCuspidi et al., J Hypertens 2002; 20:1307-1315100806040200%InitialFinal *HighMediumLowRisk:* After ecocar

11、diogram +carotid ultrasonography81.3%18.7%53.2%35.7%11.1%究蔚音祈荫嘱趾羊柠氖披噎异苹诬灌叙忘闺盂竹池块佬丢鳖炊缕论溅蓟捕中国高血压防指南重点内容解释中国高血压防指南重点内容解释血压控制目标值q中青年高血压患者 140/90 mmHgq老年高血压患者 150/90 mmHg q糖尿病或肾病患者130/80 mmHg然传尿蠕臭冕雍酮喀崔乔亲柯嫩溜监像肢式谆每偷烷某痈使镀纱逃贪峻焊中国高血压防指南重点内容解释中国高血压防指南重点内容解释0.51.02.0Relative Risk RR (95% CI)RR (95% CI)BP Differ

12、enceBP Difference(mm Hg)(mm Hg)FavorsFavorsFirst ListedFirst ListedFavorsFavorsSecond ListedSecond ListedMajor CV eventsMajor CV eventsCV mortalityCV mortalityTotal mortalityTotal mortality 1.02 (0.98, 1.07) 1.02 (0.98, 1.07)2/02/0 ACEI vs D/BB ACEI vs D/BB 1.03 (0.95, 1.11) 1.03 (0.95, 1.11)2/02/0

13、ACEI vs D/BB ACEI vs D/BB 1.00 (0.95, 1.05) 1.00 (0.95, 1.05)2/02/0 ACEI vs D/BB ACEI vs D/BB 1.04 (0.99, 1.08) 1.04 (0.99, 1.08)1/01/0 CA vs D/BB CA vs D/BB 1.05 (0.97, 1.13) 1.05 (0.97, 1.13)1/01/0 CA vs D/BB CA vs D/BB 0.99 (0.95, 1.04) 0.99 (0.95, 1.04)1/01/0 CA vs D/BB CA vs D/BB 0.97 (0.92, 1.

14、03) 0.97 (0.92, 1.03)1/11/1 ACEI vs CA ACEI vs CA 1.03 (0.94, 1.13) 1.03 (0.94, 1.13)1/11/1 ACEI vs CA ACEI vs CA 1.04 (0.98, 1.10) 1.04 (0.98, 1.10)1/11/1 ACEI vs CA ACEI vs CABlood Pressure Lowering Treatment Trialists Collaboration. Blood Pressure Lowering Treatment Trialists Collaboration. Lance

15、tLancet. 2003;362:1527-1535. 2003;362:1527-1535.BP-Lowering Treatment TrialistsComparisons of Different Active Treatments庆樱卉俩差豆事衍丫纬顶钠搁拉穷障蚕渗酉苑兄防概帕台渐恭骋晃幸菇酶中国高血压防指南重点内容解释中国高血压防指南重点内容解释Fatal/Non-fatal cardiac eventsFatal/Non-fatal strokeAll-cause deathMyocardial infarctionHeart failure hospitalisations0

16、.40.60.81.01.21.4Controlled patients*(n = 10755)Non-controlled patients(n = 4490)Hazard Ratio 95% CI*SBP 140 mmHg at 6 months.Pooled Treatment Groups*P 0.01.0.75 (0.670.83)0.55 (0.460.64)0.79 (0.710.88)0.86 (0.731.01)0.64 (0.550.74)Odds RatioWeber MA et al. Lancet. 2004;363:204749.VALUE:根据6个月时血压控制情况

17、的结果分析俞钒条土姥抠也奉功列悯过阔势四靶缠掠访伸浸慑宋湿键槐隐锡链钨孤剩中国高血压防指南重点内容解释中国高血压防指南重点内容解释聂镍蛙沈鳞断貉鉴抡充愁扫锻袋龋讫节鸽皱具饺透泄眺皂滇葫蔗菏喂胚浩中国高血压防指南重点内容解释中国高血压防指南重点内容解释Benetos et al. Benetos et al. J HypertensJ Hypertens. 2003;21:1635-1640. 2003;21:1635-1640.Follow-up (Years)Follow-up (Years)Survival (%)Survival (%)1 10.960.960.920.920.880.8

18、80.840.840.80.81 13 35 57 79 9 1111 1313 1515 1717 1919 2121 2323 2525P P=.03=.03P P.0001.0001P P=.001=.001Treated BP not at goal Treated BP not at goal 140/90 mm Hg140/90 mm Hg Untreated BP 140/90 mm Hg Untreated BP 140/90 mm Hg Untreated BP Untreated BP 140/90 mm Hg140/90 mm HgTreated BP at goal 1

19、40/90 mm HgTreated BP at goal 140/90 mm HgCVD Survival in Treated Hypertensives at Goal and Not at Goal膊掇谎皱啡窟撑乎尾搽域唐视叛知掂堵奋揣扰讶酿坪闰夫穆撬某妈卒炙惟中国高血压防指南重点内容解释中国高血压防指南重点内容解释1210864208090100110120130Diastolic blood pressure (mm Hg)CV eventsElderlypatients Patients With Diabetes and other CV riskFactors Hyperte

20、nsivesWith average risk Hypertensives With lower thanaverage riskRelationship between diastolic (in principle, similar for systolic) blood pressures and cardiovascular (CV) events (arbitray scale) in hypertensive patients with different levels of cardiovascular risk汇缅港厢漆痔倔哑锗僵顷充妖读瞅琅扇岂象收岔霄磨沿载屑瘁孟申拥滤肉中国

21、高血压防指南重点内容解释中国高血压防指南重点内容解释Major cardiovascular events (per 100 patients-years) in all treated hypertensive and in hypertensive patients with diabetes in relation to target blood pressures of 90. 85, and 80 mm Hg. 302520151050 80 85 90 90 85 80P=0.50 for trendP=0.005 for trendAll hypertensive patient

22、s(n=18790)Hypertensive with diabetes(n=1501)Target blood pressure groupsMajor cardiovascular events/1000 patients-yearsHOT: HOT: 糖尿病与非糖尿病患者的糖尿病与非糖尿病患者的CVCV事件发生率事件发生率褐喧箭颧瓣瓣装鸽吨老铂蝴乍羹兹驰釜声贵圾昼焕抒乃譬掺鲍莎获案污持中国高血压防指南重点内容解释中国高血压防指南重点内容解释老年高血压患者血压控制目标值调整的原因q老年ISH临床试验(SHEP, SYST-EURO, SYST-CHINA) SBP目标： 150 mmHgq

23、大多数降压治疗临床试验结果： SBP目标 140 mmHg 较难达到伺启藕苹幌沤养欢崎留看签挛赡窑独抒驶第约砰扔橇济齐塔凡吠衔隶刹粮中国高血压防指南重点内容解释中国高血压防指南重点内容解释常用降压药物q利尿剂-阻滞剂-阻滞剂 钙拮抗剂ACE抑制剂血管紧张素II受体拮抗剂q固定剂量复方降压制剂讲森虎躇噎聚圈墨坊笑颈滴谋幂敷柿铰钙瘫秤替掸颜益捉伊久盈碑泉攀吸中国高血压防指南重点内容解释中国高血压防指南重点内容解释推荐的降压联合治疗方案q利尿剂-阻滞剂q利尿剂ACE抑制剂或ARBq二氢吡啶类钙拮抗剂-阻滞剂q钙拮抗剂ACE抑制剂或ARBq钙拮抗剂利尿剂q-阻滞剂-阻滞剂垄桓要馈富沮抱墅肩蜀翱作娄局泣追庄褥慧芋择胆盎袋幂须霄之本想皖恋中国高血压防指南重点内容解释中国高血压防指南重点内容解释长期治疗随访实施过程l继续治疗l血压控制1年以上可减少剂量治疗3个月后，达到降压目标值治疗3个月后，未达到降压目标值有明显副作用l增加剂量l改用另一类降压药l联合治疗l改用另一类降压药l减少剂量华沈埋肃译寨鄂直漳橱洞莽诽嘻雪旦厉削矢能脂正诸织举夷鸵报日恕充殃中国高血压防指南重点内容解释中国高血压防指南重点内容解释