顽固性高血压医学课件.pptx

顽固性高血压
:难治性高血压
:患病率
:
建立继发性高血压鉴别诊断路径


定义:顽固性高血压,不是难治性高血压
Resistant hypertension or difficult to treat
高血压患者血压不能达标(<140/90 mm Hg) 或糖尿病、慢性肾病患者没有达标<130/80 mm Hg;
合适降压药组合:至少3个或3个以上不同种类降压药降压药,
包括1个利尿剂,采用最大耐受量。
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., Jones DW, Materson BJ, Oparil S, Wright JT Jr., ella EJ; Joint mittee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program mittee. Hypertension. 2007;42:69–75.
Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman WC, White W, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM; American Heart Association Professional mittee. American Heart Association Scientific Statement: resistant hypertension: diagnosis, evaluation and treatment. Circulation. 2008;51:1403–1419.
降压所药物的目标血压的争议
Recent trials have confirmed that lowering blood pressure significantly reduces the risk of cardiovascular risk, but the evidence about the degree of BP lowering below 140/90 mm Hg needs to consider patients’ associated conditions.
对脑中风,强降压(<130/80)肯定获益;对冠心病与糖尿病,the evidence of lowering less than 130/80 is less conclusive.
慢性肾病(Chronic kidney disease CKD)的定义
定义:1)All individuals with a glomerular filtration rate (GFR) <60 mL/min/ m2 for 3 months are classified as having chronic kidney disease,irrespective of the presence or absence of kidney damage.
2)All individuals with kidney damage are classified as having chronic kidney disease, irrespective of the level of GFR.
3)CKD is present when more than 30 milligrams of albumin per gram of creatinine is excreted in urine, with or without decreased eGFR.

合理性:把所有eGFR低于60的全部界定为CKD,因为这些患者肾功能损失已经超过正常***的一半以上。[National Kidney Foundation (2002). "K/DOQI clinical practice guidelines for chronic kidney disease". Retrieved 2008-06-29.]
所有肾损害的人,不管GFR水平如何(包括GFR > 60 mL/min/ m2 ),均被界定为CKD,因为肾损害初期GFR 可能保持正常