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1、ACC in ChinaHypertension, Prevention and Lipids (HPL) Jiguang WANG, MD, PhDShanghai Institute of Hypertension, Ruijin Hospital, Shanghai, CManagement of hypertension in the elderly Jiguang WANG, MD, PhDShanghai Institute of Hypertension, Ruijin Hospital, Shanghai, CnSize of the problem: hypertension
2、nCareful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harmnRoadmap to control blood pressure in resistant hypertensive patientsAwareness, treatment and control rates of hypertension in ChinaPrevalenceNumber of patientsAwareness TreatedControlled 1991
3、(15 y)11.394 million26.645.5% (12.1)23.1% (2.8)2002 (18 y）18.8160 million30.281.8% (24.7)25.0% (6.1)2002 (60 y）49.170 million37.696.3% (36.2)24.1% (7.6)Chin J Hypertens 1995;3(suppl):14 -18; Li Liming, et al. ChinJ E pidemiol 2005;26:,478-484.nSize of the problem: hypertensionnCareful selection of a
4、ntihypertensive drugs to potentiate the huge benefit and to avoid the potential harmnRoadmap to control blood pressure in resistant hypertensive patientsRelative risk reductions by antihypertensive treatment in early trialsProgression to severe HTCHFStrokeCHDTotal mortalityCV mortality-94*-53%*-40%*
5、-16%*-13%-21%*P0.05Collins R et al. Br Med Bull 1994;50:272-298.BPLTTC. Lancet 2003;362:1527-45.0-5-10-15-20-25-30StrokeCHDCHFTotal mortality -23%-15%-16%-14%4/3 mmHgN20 888Major CV events -15%Relative risk reductions by antihypertensive treatment in recent trials指南推荐指南推荐o利尿剂利尿剂o 阻滞剂阻滞剂o钙离子拮抗剂钙离子拮抗剂
6、o转换酶抑制剂转换酶抑制剂o血管紧张素受体拮抗剂血管紧张素受体拮抗剂J Hypertens 2007;25:1105-87.INTERMAP: Urinary electrolytes in menZhou BF et al. J Hum Hypertens 2003;17:623630. JapanChinaUKUSAUrinary Na(mg/day)4843563337024202Urinary Na(mmol/day)211245161183Urinary K(mg/day)1920150629122512Urinary K(mmol/day)49.238.674.764.4Urina
7、ry Na/K(mmol/mmol)4.56.82.33.1INTERMAP: Urinary electrolytes in womenZhou BF et al. J Hum Hypertens 2003;17:623630.JapanChinaUKUSAUrinary Na(mg/day)4278483929293272Urinary Na(mmol/day)186210127142Urinary K(mg/day)1891147523781982Urinary K(mmol/day)48.537.961.050.8Urinary Na/K(mmol/mmol)4.16.02.23.1H
8、YVET: Serum concentrations of cholesterol, sodium and potassiumLiu LS et al. Chin Med J 2008; 121:1509-1512.MenWomen Characteristic (mmol/L)China Other countriesChina Other countries Total cholesterol4.691.05.451.15.021.15.601.1HDL cholesterol 1.370.36 1.290.391.430.361.330.43Sodium 1404.1 1424.1140
9、4.1 1424.3Potassium 4.250.47 4.420.404.260.494.380.40SHEP: New-onset diabetes mellitusShafi T et al. Hypertension 2008;52:1022-9.45% per 0.5 mmol/L in K+nSize of the problem: hypertensionnCareful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harmnRoadm
10、ap to control blood pressure in resistant hypertensive patientsResistant Hypertension: Diagnosis, Evaluation, and Treatment. A Scientific Statement From the AHA Professional Education Committee of of thethe CouncilCouncil forfor High High BP ResearchBP ResearchHypertension 2008Pharmacologic recommen
11、dations for the treatment of resistant hypertension (1) Use of a long-acting thiazide diuretic, preferably chlorthalidone Combine agents with different mechanisms of action Recommended triple regimen of - ACE inhibitor or ARB - Calcium channel blocker- Thiazide diureticoConsider addition of mineralo
12、corticoid receptor antagonist. oUse of loop diuretic may be necessary in patients with CKD (creatinine clearance 30 mL/min). Pharmacologic recommendations for the treatment of resistant hypertension (2)Number No. drugs 2 drugsALLHAT42,4241.840%ANBP26083 2.050%ASCOT19,2572.378%CONVINCE16,6021.840%INV
13、EST22,5763.085%LIFE91932.046%VALUE15,2452.054%Number of drugs in recent large HT trialsAchieved 135/76147/82136/77136/79131/76144/81138/78Catheter-Based Renal Sympathetic Denervationfor the Management of Resistant HypertensionHenry Krum MBBS PhD FRACPCentre of Cardiovascular Research & Education in
14、Therapeutics, Monash University/Alfred Hospital;Alfred Heart Centre, The Alfred Hospital, Melbourne, AustraliaTreatments Catheter-Based Renal Sympathetic Denervationfor the Management of Resistant HypertensionHenry Krum MBBS PhD FRACPCentre of Cardiovascular Research & Education in Therapeutics, Mon
15、ash University/Alfred Hospital;Alfred Heart Centre, The Alfred Hospital, Melbourne, AustraliaResults: Blood Pressure Reduction 87% had a reductionin SBP 10 mmHgP0.001 except for DBP at 12 months (P=0.02)Conclusions Therapeutic renal sympathetic denervation produced predictable, significant, and sust
16、ained reductions in BP in patients with resistant hypertension. The brief and simple procedure was performed without significant complications to either the renal artery or the kidney. Results appear both to confirm the important role of renal sympathetic nerves in resistant hypertension and to sugg
17、est that renal sympathetic denervation could be of therapeutic benefit in this patient population. Prospective randomized clinical trials examining the treatment of hypertension are beginning in 2009, and trials in heart failure and chronic kidney disease are anticipated. 因为知晓率低、用药后血压控制率低，我国因为知晓率低、用
18、药后血压控制率低，我国90%以上的高血压患以上的高血压患者的血压未得到有效控制者的血压未得到有效控制(140/90 mm Hg)，在广大农村该比例，在广大农村该比例甚至高达甚至高达96.5%。因此，必需大幅度提高高血压检出率与治疗控。因此，必需大幅度提高高血压检出率与治疗控制率。制率。指南推荐使用的指南推荐使用的5大类降压药物均可在大类降压药物均可在50%以上的患者中发挥降以上的患者中发挥降压作用。在关注降压达标的同时，应尽可能减少降压药物的不良压作用。在关注降压达标的同时，应尽可能减少降压药物的不良反应，降低降压治疗的代价。反应，降低降压治疗的代价。联合降压治疗，特别联合使用联合降压治疗，特别联合使用3个以上药物时，不仅可以提高降个以上药物时，不仅可以提高降压达标的比例，很可能还可更有效地降低心脑血管并发症的风险。压达标的比例，很可能还可更有效地降低心脑血管并发症的风险。但即便使用多个降压药物，仍会有比例很低，但绝对数量巨大的但即便使用多个降压药物，仍会有比例很低，但绝对数量巨大的高血压患者，可能需要寻求药物以外的治疗手段，不管是外科手高血压患者，可能需要寻求药物以外的治疗手段，不管是外科手术治疗，还是介入治疗方法。术治疗，还是介入治疗方法。Thank you very much Thank you very much ！
