中國高血壓防治指南重點(diǎn)內(nèi)容解釋ppt課件

1、20192019年中國高血壓防治指南年中國高血壓防治指南重點(diǎn)內(nèi)容解釋重點(diǎn)內(nèi)容解釋重點(diǎn)內(nèi)容重點(diǎn)內(nèi)容q血壓分類和定義q心血管危險分層q血壓控制目的值q結(jié)合治療方案血壓程度的分類和定義血壓程度的分類和定義 分類 收縮壓(mmHg) 舒張壓(mmHg)正常血壓 120 和 80正常高值 120- 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 55歲q女性65歲q吸煙q血脂異常: TC5.7mmol/L(220mg/dl)q 或LDL-C3.3mmol/L(130mg/dl)q

2、 或HDL-C1.0mmol/L(40mg/dl)q早發(fā)心血管病家族史(一級親屬發(fā)病年齡38mv, Cornel2440mmmmsq 超聲心動圖LVMI或X線q頸動脈超聲IMT0.9mm或動脈粥樣斑塊q血請肌酐輕度升高q 男性 115-133mol/L或1.3-1.5mg/dlq 女性 107-124mol/L或1.2-1.4mg/dlq微量白蛋白尿q 30-300mg/24h q 白蛋白/肌酐:男性22mg/g(2.5mg/mmol)q 女性31mg/g(3.5mg/mmol)Mancia G. et al., J Hypertens 2019; 22:51-5745403530252015

3、1050None1234Additional risk factors13.7%39.8%32.4%12.1%2.0%高血壓常與其它心血管危險要素合并存在高血壓常與其它心血管危險要素合并存在%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收縮壓、微量蛋白尿與心血管危險Borch-Johnsen K, et al. Arteioscler Thr

4、omb Vasc Biol 2019; 19:1992Risk factor CV/1000 pt.yRRCl(95%)Yes NoGender(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) 11.6 9.01.29(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.

5、03(1.652.51) Ischemic Heart Disease 18.48.12.27(1.932.68) HOTHOT：心血管危險分層與：心血管危險分層與CVDCVD事件事件BMJ 2019, 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 strokeCardiovascularmo

6、rtalityTotalmortalityRisk:MediumHighVery High20151050Events per 1000 patient yearsRisk Reclassification in APROS StudyCuspidi et al., J Hypertens 2019; 20:1307-1315100806040200%InitialFinal *HighMediumLowRisk:* After ecocardiogram +carotid ultrasonography81.3%18.7%53.2%35.7%11.1%血壓控制目的值血壓控制目的值q中青年高血

7、壓患者 140/90 mmHgq老年高血壓患者 150/90 mmHg q糖尿病或腎病患者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 pa

8、tients*(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. 2019;363:204749.VALUE:根據(jù)根據(jù)6個月時血壓控制情況的結(jié)果分析個月時血壓控制情況的結(jié)果分析CVD Survi

9、val in 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,

10、similar 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

11、 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: HOT: 糖尿病與非糖尿病患者的糖尿病與非糖尿病患者的CVCV事件發(fā)生率事件發(fā)生率老年高血壓患者血壓控制目的值調(diào)整的緣由老年高血壓患者血壓控制目的值調(diào)整的緣由q老年ISH臨床實(shí)驗(yàn)(SHEP, SYST-EURO, SYST-CHINA)q SBP目的： 150 mmHgq大多數(shù)降壓治療臨床實(shí)驗(yàn)結(jié)果：q SBP目的 140 mmHg 較難到達(dá)q利尿劑qb-阻滯劑q-阻滯劑q 鈣拮抗劑qACE抑制劑q血管緊張素II受體拮抗劑q固定劑量復(fù)方降壓制劑引薦的降壓結(jié)合治療方案引薦的降壓結(jié)