高血压合理用药最新要点讨论及处方分析PPT演示.ppt

高血压合理用药最新要点讨论及处方分析
顼志敏
Xu Zhimin
中国医学科学院阜外心血管病医院
我国高血压患病率愈来愈高
百分比*
(%)
0
4
8
12
16
20
1959
18
14
10
6
2
1979
1991
2002
%

中国居民营养与健康现状调查。卫生部、科技部、统计局,2004、10、12
%
%
~8%
%
%

%
2004年全国营养与健康综合调查(18岁)
%
%
%
9400万
%
1991年全国抽样调查(>15岁以上)
控制率
服药率
知晓率
患病人数
患病率
中国高血压控制率
降压本身的益处
平均降低
卒中发生率 35–40%

心肌梗死 20–25%
心力衰竭 50%
JNC 7
收缩压降低10–12mmHg或舒张压降低5-6mmHg
1、高血压治疗四大目标
长期、有效、平稳控制血压水平
预防(逆转)心、脑、肾等靶器官的损害
减少心、脑血管疾病的发病和死亡——循证医学
改善生活质量
亚临床靶器官损害之保护
(2009,oct ESH Reappraisal)
Evidence on the important prognostic role of an damage continues to grow. In both hypertensive patients and the general population, the presence of electrocardiographic and echocardiographic LVH, a carotid plaque or thickening, an increased arterial stiffness, a reduced eGFR (assessed by the MDRD formula), or microalbuminuria or proteinuria substantially increases the total cardiovascular risk, usually moving hypertensive patients into the high absolute risk range.
合并亚临床靶器官损害常为高危者:LVH,颈动脉斑块、增厚硬化, eGFR下降,微量/蛋白尿。
----Journal of Hypertension 2009, 27:2121–2158
血压目标——低限? (ESH June, 2009 )
Key among the changes will be the mendation of a lower threshold level--around 120 mm Hg systolic and 70 mm Hg diastolic--below which it could be dangerous to reduce blood pressure in high-risk individuals, representing the so-called J-curve phenomenon, Mancia said.
J-Curve: A Narrow Window of Optimum BP for High-Risk Individuals
“J形曲线”可能存在,有些特定高危患者血压不宜过低(<120/70)
----June 16, 2009 (Milan, Italy) — The European Society of Hypertension (ESH)
血压达标(2009,oct ESH Reappraisal)
Each drug class has contraindications as well favorable effects in specific clinical settings. The choice of drug(s) should be made according to this evidence.
The traditional ranking of drugs into first, second, third,
and subsequent choice, with an average patient as reference, has now little scientific and practical justi