高血压与血管弹性研究生资料.ppt

* 既然诊室血压的变化并不能代表降压质量的全部，下面就让我们逐一关注降压质量的其他方面。 * FDA认为理想的降压效应应保持大部分的峰值效应，亦即谷峰效应至少是峰值效应的50%以上，即T/P≥50%。如果峰值效应时血压仅降低5mmHg，则T/P≥70%。如果T/P比率接近100%，则表示整个用药期间均有抗高血压作用。 * 首先介绍什么是血压变异性。 18世纪，人们意识到血压不是恒定的，而是在一定范围内波动的。1969年，英国人首次运用动脉内插管技术对人的血压进行了连续监测，对血压的自发性波动有所了解。20世纪80年代，形成了血压变异性的概念。血压变异性的高低反映血压波动的程度，是各时段血压值标准差与24小时平均动脉压的百分比。 * 那么血压变异性增强有什么临床意义呢？ 首先，血压变异性增高显著增加心血管事件发生率。 在一项研究中，286例高血压患者随访3.3年，观察血压变异性对早期动脉粥样硬化和心血管事件发生率的影响。如图所示，血压变异性高（ 15mmHg ）的患者，其发生心血管事件的比例高于血压变异性低（ ≤15mmHg ）的患者。 * 这里介绍了平滑指数(SI)的基本概念，降压药物治疗后，24小时内每小时血压下降的均值与期标准差的比值，即为平滑指数（SI）。平滑指数反映了一种降压药物降压是否平稳。高SI值药物可以减少血压的变异性，SI值同样可以用来评价药物的靶器官保护。 * This is the Main Title Slide There is no Master for this particular slide, as it is used only once for each presentation. To use this slide in your presentation, merely retype the title and the list of participating doctors. * Mortality is very high in patients with severe PAD Risk of death associated with peripheral arterial disease (PAD) is as high as for many common cancers.1 In a US study of 744 patients tested for PAD, those with severe PAD (ABI 0.4) had a 5-year survival probability of only 56%.2 This is comparable to the 52% survival probability in white patients with non-Hodgkin’s lymphoma, as recorded from 1986–1993 by Ries et al.3 Data for colon and breast cancer are reported in the same source. References: 1. Criqui MH. Peripheral arterial disease - epidemiological aspects. Vasc Med 2001; 6 (suppl 1): 3–7. 2. McKenna M et al. The ratio of ankle and arm arterial-pressure as an independent predictor of mortality. Atherosclerosis 1991; 87: 119–128. 3. Ries LAG et al. (Eds). SEER Cancer Statistics Review, 1973–1997. US: National Cancer Institute; 2000. * Peripheral arterial disease (PAD) patients have widespread arterial disease, and are more likely to develop coronary artery and cerebrovascular disease than healthy individuals. In a follow-up study investigating the relationship between PAD and mortality from all causes, mortality rates of 61.8% after 10 year