中国高血压防治指南培训手册讲稿.pptVIP

《中国高血压防治指南》培训手册 Hypertension高血压 Definition Hypertension is defined as a SBP of 140 mmHg or greater and/or a DBP of 90 mmHg or greater in subjects who are not taking antihypertensive medication. 95% Essential or primary hypertension 5% Secondary hypertension Epidemiology Prevalence rate（患病率） of hypertension in China: In 1959------ 5.11% In 1979------7.73% In 1991------11.88% In 2004------18.80% The prevalence of high BP increases with age. Hypertension is more common in men than in women up to age 50, after that age, hypertension is more common in women. Hypertension is more common in northern China than in southern China. Etiology and pathogenesis of EH No cause can be established Possible factors ? Genetic tendency Spontaneous hypertension rat EH tends to cluster in families ?Environemnts Pathogenesis of EH sympathetic nervous system activity? RAAS 肾脏潴钠 Vessel remolding Vascular endothelium dysfunction nitric oxide? endothelin? ? Insulin resistance (胰岛素抵抗) sodium reabsorption?, sympathetic nervous system activity?, intracellular Na Ca? 病 理 血管：全身细小动脉病变?大中动脉病变 心：左心室后负荷增加?心肌肥厚 与扩大?心力衰竭；动脉粥样硬化 脑：脑小动脉硬化。脑血栓、脑出血、 　　　脑水肿 肾：肾细小动脉硬化。肾单位萎缩? 肾功能衰竭 Clinical findings BP波动---，White coat EH Symptoms----- Mild to moderate EH is usually associated with normal health for many years. Some patients have headache, tinnitus（耳鸣）, palpitation, tiredness（疲劳）, and so on. Signs----- BP is elevated. Some patients have a loud aortic second sound and an early systolic ejection click(收缩期喷射喀喇音). Clinical findings(Continue) Complications : ?Hypertensive cardiovascular disease, CHD ? Hypertensive cerebrovascular disease Hypertension is the major predisposing cause of stroke. ? Hypertensive renal disease Chronic hypertension leads to nephrosclerosis(肾硬化症) ? Aortic dissection（主动脉夹层） blood pressure me