高血压合并糖尿病患者的血压控制和靶器官保护.ppt

患者已经停用蒙诺，体格检查时血压150/90mmHg,为什么这里说是高血压2级？ 2. 应该说LDL-C没有达标。 3. 能给出患者的心电图吗？这是新的欧洲指南I类推荐的评估无症状靶器官损伤的检查手段。 1.建议写成左心室肥厚 * * 2010版《中国高血压防治指南》指出，对于基线血压≥160mmHg的患者或某些高危患者，固定复方制剂可以作为初始治疗。 固定复方制剂分别处方的降压联合治疗相比，使用方便，可改善治疗的依从性及疗效，是联合治疗的新趋势。 * * 联合用药方案中药物的选择在抗高血压的治疗中具有重要意义1 。 作用机制互补的不同药物联合如可获得比单药更好的效果及更好的耐受性，则优先进行联合治疗1 。 随机临床试验显示，血管紧张素II受体阻断剂(ARB)如氯沙坦与噻嗪类利尿剂如HCTZ ，联合应用有效且耐受性良好1 。 正如本幻灯片所示，噻嗪类利尿剂通过排钠和减少血容量而降低血压，但是，这些效应也激活肾素-血管紧张素系统(RAS) ，最后导致肾素释放，循环血管紧张素II (AII)增加，血管收缩，钠滞留，并最终导致血压升高2 。 血管紧张素II受体阻滞剂可以阻断RAS 的激活，因而血管舒张，钠和血容量减少。通过这些机制， ARB的互补作用可增强噻嗪类利尿剂的降压作用2 。 从海捷亚?（氯沙坦钾氢氯噻嗪）的说明书，我们可以明确地看到，海捷亚?适用于联合用药治疗的患者。 * COA027How Does The Dual Combination Of ARBs+HCTZ Compare To Oth er Dual Combinations In The Treatment Of Hypert ension? Petrella RJ1, KOA H2 Objectives The association between blood pressure and risk of cardiovascular disease is well established. ■ The efficacy of dual anti-hypertensive therapies combining Angiotensin Receptor Blockers (ARBs) or ACE Inhibitors (ACEIs) with another agent such as diuretics or Calcium Channel Blockers (CCBs) as assessed in randomized clinical trials does not necessarily reflect what is observed in a real-world setting. ■ The objective of this retrospective analysis is to compare the effectiveness of dual combinations of ARBs and ACEIs with hydrochlorothiazide (HCTZ) or CCBs in reaching target blood pressure (BP) in a real-world setting Methods The South Western Ontario (SWO) database consisting of more than 170,000 primary care patients in 53 rural and urban practice clinics, was used in this analysis. ■ The SWO study is a longitudinal investigation in a geographically defined area consisting of the city of London, Ontario, Canada and surrounding counties with catchments of 1.5 million inhabitants. ■ The ‘trigger’ for an update of a record is a billed patient encounter and each quarter, the cohort database is updated in terms of clinical activity including hospitalizations, morbidity and mortality. Data is extracted by chart-abstraction at th