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1、20042004年中国高血压防治指南年中国高血压防治指南重点内容解释重点内容解释重点内容重点内容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联合治疗方案血压水平的分类和定义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 90 1级 140-159 或 90-99 2级 160-179 或 100-109 3级 180 或 110单纯收缩期高血压 140 和 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(130mg/dl
2、) 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)Mancia G. et al., J Hypertens 2004; 22:51-57454035302520151050No
3、ne1234Additional risk factors13.7%39.8%32.4%12.1%2.0%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%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 Va
4、sc Biol 1999; 19:1992Risk factor CV/1000 pt.yRRCl(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
5、.51) Ischemic Heart Disease 18.4 8.12.27(1.932.68) 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 strokeCardiovascularmortality
6、TotalmortalityRisk:MediumHighVery High20151050Events per 1000 patient yearsRisk Reclassification in APROS StudyCuspidi et al., J Hypertens 2002; 20:1307-1315100806040200%InitialFinal *HighMediumLowRisk:* After ecocardiogram +carotid ultrasonography81.3%18.7%53.2%35.7%11.1%血压控制目标值血压控制目标值q中青年高血压患者 140
7、/90 mmHgq老年高血压患者 150/90 mmHg q糖尿病或肾病患者130/80 mmHg0.51.02.0Relative RiskBP-Lowering Treatment TrialistsComparisons of Different Active TreatmentsFatal/Non-fatal cardiac eventsFatal/Non-fatal strokeAll-cause deathMyocardial infarctionHeart failure hospitalisations0.40.60.81.01.21.4Controlled patients*
8、(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:根据根据6个月时血压控制情况的结果分析个月时血压控制情况的结果分析CVD Survival in
9、Treated Hypertensives at Goal and Not at Goal1210864208090100110120130Diastolic blood pressure (mm Hg)CV eventsElderlypatients Patients With Diabetes and other CV riskFactors HypertensivesWith average risk Hypertensives With lower thanaverage riskRelationship between diastolic (in principle, similar
10、 for systolic) blood pressures and cardiovascular (CV) events (arbitray scale) in hypertensive patients with different levels of cardiovascular riskMajor cardiovascular events (per 100 patients-years) in all treated hypertensive and in hypertensive patients with diabetes in relation to target blood
11、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: 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老年高血压患者血压控制目标
12、值调整的原因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大多数降压治疗临床试验结果： SBP目标 140 mmHg 较难达到q利尿剂b-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推荐的降压联合治疗方案推荐的降压联合治疗方案q利尿剂b-阻滞剂q利尿剂ACE抑制剂或ARBq二氢吡啶类钙拮抗剂b-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b-阻滞剂长期治疗随访实施过程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
中国高血压防指南重点内容解释
