高血压合理用药最新要点及处方PPT.ppt

高血压合理用药最新要点讨论及处方分析;顼志敏介绍 XU Zhimin 中国医学科学院阜外心血管病医院主任医师、教授、博士 国家心血管病中心专家委员中国临床药理分会 委员 中华全科医学分会 常委 北京高血压学会 常委 中美脑中风协作组 药物治疗核心专家 中国健康教育中心专家咨询委员会专家 中国老年保健协会心血管专业委员会常委 ;高血压;高血压与心脏损害;6.1 ％ ~8%;2009中国高血压门诊控制率仅为31.1%合并并发症的患者达标率更低;心血管疾病的发生34.5%与高血压相关;降压本身的益处; 美国;中国高血压人群的临床特点;降低心脑血管事件是降压治疗的根本目的;2009中国高血压指南（基层版）要点;1、高血压治疗四大目标 ;何时开始用药 (2009,oct ESH Reappraisal) it appears reasonable to recommend that, in grade 1 hypertensives (SBP 140–159mmHg or DPB 90–99mmHg) at low and moderate risk, drug therapy should be started after a suitable period with lifestyle changes. Prompter initiation of treatment is advisable if grade 1 hypertension is associated with a high level of risk, or if hypertension is grade 2 or 3. 立即用药：a）2或3级高血压; b）1级HT +高危 改善生活方式后用药：1级HT +低、中危 ;亚临床靶器官损害之保护 (2009,oct ESH Reappraisal) Evidence on the important prognostic role of subclinical organ 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 所有患者 140/90 140/90 DM/肾病 130/80(DM) 130/80 冠心病：130/80 mm Hg (2007/2009年欧洲高血压指南) *老年SBP难于140可适当灵活些(尤低危者)， 老年收缩压可降至150 mm Hg以下 ;血压目标 ——低限？ (ESH June, 2009 ) Key among the changes will be the recommendation 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 (Mila