H型高血壓優(yōu)化防治方案

1、H型高血壓優(yōu)化防治方案2007年我國腦卒中發(fā)病率不斷上升亞太NO12020年腦卒中180萬/年腦卒中發(fā)病將達(dá)370萬/年8.7%/年Zhao et al, Stroke, 2008 (國際“卒中”雜志上發(fā)表的中國-MONICA-北京調(diào)查結(jié)果 )東西方心腦血管疾病分布差異AHA Heart Disease and Stroke Statistics -2009 update Report on CVD in China 2006Fourth National Survey on Health Service /publicfiles 患病例數(shù)（百萬）NOTES: Estimates are ag

2、e-adjusted. Starting with 1999 data,causes of death were coded according to ICD10.SOURCE: CDC/NCHS, National Vital Statistics System.ChartbookHealth, United States, 2008冠心病和腦卒中死亡率趨勢及中美比較Stroke1950196019701980199020002005Year10,00010010Deathsper100,000population(logscale)Heart disease1985199019952000

3、2005Year1501000Mortality(1/100000)50USALisheng Liu, Cardiovascular diseases in China, Biochem. Cell Biol. 85: 157163 (2007)StrokeCHD13854211.146.6ChinaAsian Pacific Region Stroke (2002)127.6105.997.372.668.465.557.056.343.242.441.039.931.0020406080100120140ChinaJapan South KoreaVietnamMyanmarLaosInd

4、onesiaUSACambodiaMalaysiaSingaporeThailandPhilippinesIncidence per 100,000Atlas of Heart Disease and Stroke. MacKay J & Mensah G. 2004. Geneva. WHO Figures (not adjusted for age). Stroke is more common than MI in Hypertension-Analysis based on 11 Major Randomized Intervention TrialsSTOP-1 SHEPSTONE*

5、SYST-EURSYST-CHINA*HOTCAPPPSTOP-2NICS*NORDILINSIGHT19911991199619971998199819991999199920002000767267706761537670606716274736163246952394187901098566144141088657582269521241042943404522035514153165478162093272934340138Year ofPublicationAverage age (yrs)No.patientsrandomized No.strokesStudyAcronymTot

6、al 2233 1627 1.37 Blood Pressure 2001; 10: 190-2* Studies were conducted in China* Study was conducted in JapanStroke:MIratio 1.54 1.6313.00 1.58 6.56 1.41 1.04 1.54 5.00 1.04 1.02No.MI傳統(tǒng)”三高”無法解釋中國腦卒中高發(fā)現(xiàn)象高血壓 腦卒中危險因素高血脂高血糖 潛伏的答案HCY對比觀察美國中國腦卒中年發(fā)病(死亡)率70(57)280(128)腦卒中：冠心病（高血壓患者）約1-2：1約7-13：1高血壓32%19%高

7、膽固醇血癥31%3%糖尿病24%10%血漿Hcy水平約10-12mol/L約15mol/LSOURCE: CDC/NCHS, National Vital Statistics SystemReport on Cardiovascular Diseases in China (2008-2009)N Engl J Med 2006;2010；北京大學(xué)學(xué)報(醫(yī)學(xué)版) 2007(39)歐洲：薈萃分析結(jié)論研究類型研究數(shù)例數(shù)相對危險度合計危險度缺血性心臟病:MTHFR46121931.43(1.11 to 1.84)前瞻性研究*1631441.32(1.19 to 1.45)深部靜脈血栓:MTHFR2

8、634391.60(1.15 to 2.22)腦卒中:MTHFR712171.65(0.66 to 4.13)前瞻性研究*86761.59(1.29 to 1.96)1.33(1.22 to 1.46)1.59(1.30 to 1.95)同型半胱氨酸增加 5mol / LBMJ,2002,325:1202-1206 中國39165例10年跟蹤hcy流行病學(xué)研究* Li J et al. 2009 (paper under review)Hcy水平發(fā)生概率心血管事件腦血管事件心血管事件死亡腦血管事件死亡 中國:安慶社區(qū)研究最新歐洲指南：Hcy是動脈粥樣硬化和腦卒中/TIA的獨(dú)立危險因素中國新指南

9、，重視中國特點(diǎn)我國是腦卒中的高發(fā)區(qū)，高血壓的主要并發(fā)癥是腦卒中血同型半胱氨酸升高水平與腦卒中風(fēng)險正相關(guān)，降低同型半胱氨酸顯著降低腦卒中我國高血壓人群伴有Hhcy*比例較高（H型高血壓占75%）HHcy*是影響高血壓患者心血管事件預(yù)后的重要因素，指導(dǎo)高血壓高危分層管理HHCY*檢測具有臨床診斷、篩查和防治干預(yù)價值的界值10mol/L價格低廉的多效固定復(fù)方制劑“依那普利/葉酸片” ，具有降低心腦血管事件綜合干預(yù)的優(yōu)效性* HHCY 高同型半胱氨酸血癥縮寫JANA.2004；7；11-24Circulation 2006;113;e409-e449 2006年美國AHA指南，高同型半胱氨酸血癥 10

10、umol/L心腦血管可防可控的“五高”危險因素1、JAMA. 1997;277:1775-17812、Diabetes Care 1999; 22(2):233-240. 3、Epidemiology，1999，10(4)：391 高Hcy與高血壓顯著增加血管疾病風(fēng)險JAMA. 1997,277:1775-1781中國H型高血壓發(fā)生率* AHA,血漿thcy10umol/L* Beijing Da Xue Xue Bao2007;39:614-8 中國：75%高血壓患者伴有高HCY H型高血壓（H-type Hypertension）伴有血漿同型半胱氨酸升高(Hcy10umol/L)的原發(fā)性高血壓定義為H型高血壓Hypertensive pa