高血壓聯(lián)盟與轉(zhuǎn)化醫(yī)學(xué)課件

高血壓聯(lián)盟與轉(zhuǎn)化醫(yī)學(xué)

劉力生PurposeofWHLTodeveloporpromotehealthbyeducatingandinstructinghealthcareprofessionalsandthepubliconpreventativeandcurativemeasuresforhypertension.對(duì)專業(yè)人員和群眾進(jìn)行

健康促進(jìn)教育Topromoteandconductresearchrelatedtothepreventionandtreatmentofhypertension促進(jìn)和組織防治高血壓的研究項(xiàng)目

Topromotethedetection,controlandpreventionofhypertensioninthepopulationthroughjointeffortsofallnationalleaguesandsocieties.

聯(lián)合各國的聯(lián)盟與學(xué)會(huì)促進(jìn)高血壓防控工作Toliaisewiththenationalbodies,promotingtheexchangeofinformationamongthem,andofferinginternationallyapplicablemethodsandprogramsforhypertensioncontrol.與各國家團(tuán)體聯(lián)系,交流提供有關(guān)控制高血壓的國際可行的方法與計(jì)劃.轉(zhuǎn)化醫(yī)學(xué)與中國高血壓聯(lián)盟轉(zhuǎn)化醫(yī)學(xué)是本世紀(jì)從循證醫(yī)學(xué)發(fā)展而形成的一個(gè)醫(yī)學(xué)實(shí)踐和干預(yù)性流行病學(xué)的理念，它融匯基礎(chǔ)科學(xué)、社會(huì)科學(xué)、政治科學(xué)于一體，兼顧治病和預(yù)防，其涵蓋的領(lǐng)域已超出現(xiàn)行醫(yī)療保健服務(wù)的范疇。Frombenchtobedsidetopopulation(實(shí)驗(yàn)室—臨床—社區(qū)）

轉(zhuǎn)化醫(yī)學(xué)研究可分為： 1期：基礎(chǔ)實(shí)驗(yàn)研究 2期：基礎(chǔ)研究應(yīng)用于臨床:臨床試驗(yàn),中國高血壓指南 3期：改變環(huán)境與政策層面的因素才能做到臨床公共衛(wèi)生和預(yù)防措施的可持續(xù)發(fā)展。健康促進(jìn)與社區(qū)防治

HypertensionClinicalTrials

中國臨床試驗(yàn)的經(jīng)驗(yàn)

LiuLishengChronicDiseaseinChina

-2007CVDReportofChina

中國慢病現(xiàn)狀Newonsetstroke:2million/yr，Survivedstroke:13millionCVDpatients:230millionNewonsetMI:

0.5million，survivedMI:3million；CHD:8milllionPatientswithchronicdiseasesin2003:574million：DM: 33million--Cancer: 46millionCerebrovasculardiseases: 93millionCardiacdisease:

165millionHypertension: 237millionTrialsYearContributionsSyst.-ChinaChineseSystolicHT

intheElderlyTrial1998Totalmortality,CVDmortality&StrokemortalityreducedbyCCBbasedtreatmentinisolatedsystolicHTptsPATsPostStrokeAntiHTTreatmentStudy1996BPreductioninpoststrokepts.Reducedstrokerecurrence,eveninnormotensiveSTONEAntihypertensive

tr.in

elderlyCCBeffectiveinstrokereductioninelderhypertensivesFEVERChineseFelodipineEventReductionTrial2004MoreorlessantihypertensivetreatmentonstrokeHypertensionClinicalTrialsinChinaTrialsYearContributionsPROGRESSThePerindoprilProtectionAgainstRecurrentStrokeStudy

2001PoststrokeantihypertensivetreatmenteffectivelyreducedtherecurrenceofstrokeinpatientssufferedfromstrokeCREATEClinicalTrialofReviparinandMetabolicModulationinAcuteMyocardialInfarctionTreatmentEvaluation2005PostMI:useofreviparinisbeneficialADVANCEActionindiabetes&VascularDisease:PreteraxandDiamicaronMrControlledEvaluaton2006Antihypertensivetr.reducetheeventsofmacro-andmicro-vasculareventsinpatientswithDM(bloodpressurearm)InternationalTrialsTrialsYearContributions&problemsWAVETheWarfarinAntiplateletVascularEvaluationStudymorehemorragicsideeffectsinChineseOASIS-6OrganizationfortheAssessmentofStrategiesforIschemicSyndromes-62006POISEEffectsofextended-releasemetoprololsuccinateinpatientsundergoingnon-cardiacsurgery2008InternationalTrialsTrialsYearContributionsONTARGET/TRANSENDOngoingTelmisartanAloneandinCombinationwithRamiprilGlobalEndpointtrial/TelmisartanRandomizedAssessmentStudyinACEIntolerantSubjectswithCVD2008RASblocadetreatmenteffectivelyreduceCVDeventswitheitherACEIorARBratherthanbothHYVETTheHypertensionintheVeryElderlyTri2008AntihypertensivetreatmentreducedmajorCVDeventsandmortalityinveryelderly(>=80yrs)hypertensivepatientsInternationalTrialsExperience(1/2)Easiertorecruitparticipantsfromclinicsor

communities.

Concommitantdrugtreatmentareless.

largesimpletrialsarefeasible

inChina.Example:Chinesesubjects

inHYVET

(40%oftotalsample)Slightlyyounger,lighter&shorter.Smokedmorebutdranklessalcohol.LesspreviousepisodesofMI,morepreviousstrokeHadlowerbloodurea,uricacidandCr,higherHDLC.Bloodglucose&TC,Na&K,bloodhaematocrit&Hbwerealllower.Mucheasiertorecruit,lessconcomitanttr.Morecomplianttotr.EasiertoFU.Experience(2/2)CHLwasestablishedontopofSyst.-China&PATsCollaborativegroup(31medicaluniversities)in1989&continuingonorganizingRCTsbothnationally&internationalyEstablishedgoodrelationshipwithworldwellknownRCTCenters,implicatingRCTresultsinChinesepopulationsuccessfully.Forex.CCBbasedtr.usedwidelyinISH,captoprilinpostMIafterSyst-ChinaandCCS1trials.Translationalmedicineisatwo-way

streetDrivetocureshouldbecomplementedbygoingbackfrombedsidetolaboratorywith

observationsmadeinhumanstudiesPharmacogenetics

&individualized

medicineWarfarin

dosage

inAsianpeopleCanfolicacidpreventstroke?ChinaStrokePrimaryPreventionTrial

Warfarinmaintenancedosesvaryamongdifferentpopulations:Asiansrequirelowerdoses

EthnicityWarfarindoseReferencesAsianChinese3.3(mg/day)Q.J.Med.89,127-135Japanese3.3(mg/day)Clin.Pharmacol.Ther.63,519-528CaucasianAmerican5.1(mg/day)JAMA,287,1690-1698.Italian5.5(mg/day)Blood,105,645-649.“CertainsinglenucleotidepolymorphismsintheVKORC1gene(especiallythe-1639G>Aallele)havebeenassociatedwithlowerdoserequirementsforwarfarin”.DescriptionofcurrentchangestotheCrestorlabelInapharmacokineticstudyinvolvingadiversepopulationof

AsiansresidingintheUnitedStates,rosuvastatindruglevels

werefoundtobe

elevatedapproximately2-fold

comparedwithaCaucasiancontrolgroup.Asaresultofthesefindings,the“DosageandAdministration”sectionofthelabelnowstatesthatthe

5mgdoseofCrestorshouldbeconsideredasthestartdoseforAsianpatients

andanyincreaseindoseshouldtakeintoconsiderationtheincreaseddrugexposureinthispatientpopulation.Resultsofthispharmacokineticstudyarefurtherdiscussedunderthe“ClinicalPharmacology”and“Precautions”sectionoflabeling.EthnicallyDifferentDoseRecommendationPharmacogenetics

&individualized

medicineWarfarin

dosageinRCT(wavestudy)Canfolicacidprevent

stroke?

ChinaStrokePrimary

PreventionTrial中國高血壓指南項(xiàng)目設(shè)計(jì)開放性、多中心的橫斷面觀察性登記研究，入組已接受降壓藥物治療的門診高血壓患者全國22個(gè)城市，100家三甲醫(yī)院涉及心血管科、腎內(nèi)科、內(nèi)分泌科納入5000例高血壓患者以下問題為本研究關(guān)注重點(diǎn)：-患者的人口學(xué)特征-患者的血壓控制情況-患者的心血管危險(xiǎn)因素及相關(guān)實(shí)驗(yàn)室檢查結(jié)果-患者的降壓藥物應(yīng)用情況-患者的關(guān)于高血壓治療的認(rèn)知狀況的調(diào)查Surveyof

hyperTensive

pAtienTs

blood

pressUre

controlrateinclinic

Service兩大權(quán)威機(jī)構(gòu)聯(lián)合發(fā)起并主辦總結(jié)三甲醫(yī)院心血管科、腎內(nèi)科、內(nèi)分泌科門診高血壓患者血壓<140/90mmHg達(dá)標(biāo)率為45.1%糖尿病或腎病患者血壓(<130/80mmHg)和其他患者（<140/90mmHg）血壓達(dá)標(biāo)率為31.1%最常見的合并疾病依次為血脂異常(43.2%)、糖尿病(37.1%)、冠心病(22.6%)及腎功能不全(18.3%)68.9%1992--1994199820022009BP未達(dá)標(biāo)BP達(dá)標(biāo)已接受治療的高血壓患者中血壓<140/90mmHg不斷提高！2006年中國心血管病報(bào)告0%20%40%60%80%100%87.3%80.1%75%54.9%12.7%19.9%25.0%87.3%80.1%75%54.9%12.7%19.9%25.0%45.1%68.9%31.1%31.1%45.1%CHINASTATUS數(shù)據(jù)引發(fā)的思考但我們?nèi)匀幻媾R挑戰(zhàn)31.1%的達(dá)標(biāo)率對(duì)我們是否已經(jīng)足夠好?多數(shù)高血壓患者合并其他疾病，降壓需要更關(guān)注器官的保護(hù)60%的患者從不漏服降壓藥物，而總體達(dá)標(biāo)率31.1%，(<140/90mmHg為45.1%)提示我們是否應(yīng)該選擇更強(qiáng)更有效的治療方案，以使血壓盡早達(dá)標(biāo)。

我們?nèi)砸獮樘岣呶覈哐獕夯颊叩闹獣月?，治療率和達(dá)標(biāo)率、繼續(xù)努力！繼續(xù)教育與宣傳群眾可持續(xù)發(fā)展的社區(qū)防治EpidemiologicalreportfromChinaDATAFROM5-AND10–YEARFOLLOW-UPSURVEYSOF10,450WORKERS