中國高血壓防治指南重點內(nèi)容解釋課件

1、2004年中國高血壓防治指南重點內(nèi)容解釋重點內(nèi)容血壓分類和定義心血管危險分層血壓控制目標(biāo)值聯(lián)合治療方案血壓水平的分類和定義 分類 收縮壓(mmHg) 舒張壓(mmHg)正常血壓 120 和 80正常高值 120-139 或 80-89高血壓 140 或 90 1級 140-159 或 90-99 2級 160-179 或 100-109 3級 180 或 110單純收縮期高血壓 140 和 90Systolic Blood Pressure 150 mmHg160 mmHg140 mmHg130 mmHg120 mmHg100806040200020406080100False-positiv

2、e error rate (%)SensitivityPater C. Current Controlled Trials in Cardiovascular Medicine. 2005,6 : 5Vasan et al. N Engl J Med. 2001;345:1291-1297.High-Normal BP and CVD RiskFramingham StudyWomen1086420Time (years)02468101214P.001MenCumulative Incidence (%ime (years)02468101214P.001High

3、normal 130-139/85-89 mm Hg Normal 120-129/80-84 mm Hg Optimal 120/80 mm HgPrehypertensionResidual Lifetime Risk of Hypertension in Women and Men Aged 65 Years10080604020002468101214161820Years of Follow-upRisk of Hypertension, %Women Aged 65 Years1967-19981952-1975A10080604020002468101214161820Years

4、 of Follow-upMen Aged 65 YearsBVasan RS. JAMA 2002;287:1003-1010心血管危險水平分層 血壓(mmHg)1級2級3級SBP 140159或 SBP 160179或 SBP180或DBP 9099 DBP 100109 DBP110I無其它危險因素低危中危高危II12個危險因素中危中危很高危III3個危險因素高危高危很高?；虬衅鞴贀p害或糖尿病IV并存臨床情況很高危很高危很高危其它危險因素和病史Mancia G. et al., J Hypertens 2004; 22:51-57454035302520151050None1234Add

5、itional risk factors13.7%39.8%32.4%12.1%2.0%5221518123546176高血壓常與其它心血管危險因素合并存在%Microalbuminuria6543210Relative risk of IHDSBP 160Normoalbuminuria2.5 (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)收縮壓、微量蛋白尿與心血管危險Borch-Johnsen K, et al. Arteioscler Thromb Vasc Biol 1999; 19:1992HOT 心

6、血管危險因素研究血壓水平以外的各項因素對CVD發(fā)生率的影響Risk factor CV/1000 pt.yRRCl(95%)YesNoGender(M vs F)12.07.21.62(1.421.94)Age(65 vs 65 yrs)15.07.32.06(1.772.39)Smoking 14.08.91.57(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) 21.88.72.50(2.033.07) Diabetes 18.39.02.03(1.

7、652.51) Ischemic Heart Disease 18.48.12.27(1.932.68) 0.51.02.0Relative Risk RR (95% CI)BP Difference(mm Hg)FavorsFirst ListedFavorsSecond ListedMajor CV eventsCV mortalityTotal mortality 1.02 (0.98, 1.07)2/0 ACEI vs D/BB 1.03 (0.95, 1.11)2/0 ACEI vs D/BB 1.00 (0.95, 1.05)2/0 ACEI vs D/BB 1.04 (0.99,

8、 1.08)1/0 CA vs D/BB 1.05 (0.97, 1.13)1/0 CA vs D/BB 0.99 (0.95, 1.04)1/0 CA vs D/BB 0.97 (0.92, 1.03)1/1 ACEI vs CA 1.03 (0.94, 1.13)1/1 ACEI vs CA 1.04 (0.98, 1.10)1/1 ACEI vs CABlood Pressure Lowering Treatment Trialists Collaboration. Lancet. 2003;362:1527-1535.BP-Lowering Treatment TrialistsCom

9、parisons of Different Active TreatmentsFatal/Non-fatal cardiac eventsFatal/Non-fatal strokeAll-cause deathMyocardial infarctionHeart failure hospitalisations0.40.60.81.01.21.4Controlled patients*(n = 10755)Non-controlled patients(n = 4490)Hazard Ratio 95% CI*SBP 140 mmHg at 6 months.Pooled Treatment

10、 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:根據(jù)6個月時血壓控制情況的結(jié)果分析Benetos et al. J Hypertens. 2003;21:1635-1640.Follow-up (Years)Survival (%)10.960.920.880.840.8135791113151719212325P=.03P.0001P=.001Trea

11、ted BP not at goal 140/90 mm Hg Untreated BP 140/90 mm Hg Untreated BP 140/90 mm HgTreated BP at goal 140/90 mm HgCVD Survival in Treated Hypertensives at Goal and Not at GoalMajor cardiovascular events (per 100 patients-years) in all treated hypertensive and in hypertensive patients with diabetes i

12、n 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 patients(n=18790)Hypertensive with diabetes(n=1501)Target blood pressure groupsMajor cardiovascular events/1000 patients-yearsHOT: 糖尿病與非糖尿病患者的CV事件發(fā)生率老年高血壓患者血壓控制目標(biāo)值調(diào)整的原因老年ISH臨床試驗(SHEP, SYST-EURO, SYST-CHINA) SBP目標(biāo)： 150 mmHg大多數(shù)降壓治療臨床試驗結(jié)果： SBP目標(biāo) 140 mmHg 較難達(dá)到常用降壓藥物利尿劑b-阻滯劑-阻滯劑 鈣拮