老年高血壓患者的治療課件

1、ACC in ChinaHypertension, Prevention and Lipids (HPL) Jiguang WANG, MD, PhDShanghai Institute of Hypertension, Ruijin Hospital, Shanghai, ChinajiguangwManagement of hypertension in the elderly Jiguang WANG, MD, PhDShanghai Institute of Hypertension, Ruijin Hospital, Shanghai, ChinajiguangwSize of th

2、e problem: hypertensionCareful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harmRoadmap to control blood pressure in resistant hypertensive patientsAwareness, treatment and control rates of hypertension in ChinaPrevalenceNumber of patientsAwareness Tr

3、eatedControlled 1991 (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.Size of the problem: hypertensionCar

4、eful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harmRoadmap to control blood pressure in resistant hypertensive patientsRelative risk reductions by antihypertensive treatment in early trialsProgression to severe HTCHFStrokeCHDTotal mortalityCV morta

5、lity-94*-53%*-40%*-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 trialsINTERMAP: Urinary

6、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)4.16.02.23.1HYVET: Serum concentrations of cholesterol, sodiu

7、m 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 1424.11404.1 1424.3Potassium 4.250.47 4.420.404.260.494.3

8、80.40SHEP: New-onset diabetes mellitusShafi T et al. Hypertension 2008;52:1022-9.45% per 0.5 mmol/L in K+Consider addition of mineralocorticoid receptor antagonist. Use of loop diuretic may be necessary in patients with CKD (creatinine clearance 30 mL/min). Pharmacologic recommendations for the trea

9、tment of resistant hypertension (2)Number No. drugs 2 drugsALLHAT42,4241.840%ANBP26083 2.050%ASCOT19,2572.378%CONVINCE16,6021.840%INVEST22,5763.085%LIFE91932.046%VALUE15,2452.054%Number of drugs in recent large HT trialsAchieved 135/76147/82136/77136/79131/76144/81138/78Catheter-Based Renal Sympathe

10、tic Denervationfor the Management of Resistant HypertensionHenry Krum MBBS PhD FRACPCentre of Cardiovascular Research & Education in Therapeutics, Monash University/Alfred Hospital;Alfred Heart Centre, The Alfred Hospital, Melbourne, AustraliaTreatments Results: Blood Pressure Reduction 87% had a re

11、ductionin SBP 10 mmHgP0.001 except for DBP at 12 months (P=0.02)Conclusions Therapeutic renal sympathetic denervation produced predictable, significant, and sustained reductions in BP in patients with resistant hypertension. The brief and simple procedure was performed without significant complicati

12、ons 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 suggest 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. 因為知曉率低、用藥后血壓控制率低，我國90%以上的高血壓患者的血壓未得到有效控制(140/90 mm Hg)，在廣大農村該比例甚至高達96.5%。因此，必需大幅度提高高血壓檢出率與治療控制率。指南推薦使用的5大類降壓藥物均