从高血压到心力衰竭挑战与对策-课件，.pptVIP

从高血压到心力衰竭挑战与对策 高血压: 心力衰竭的主要危险因素Framingham Heart Study 血压水平与心力衰竭危险 降压治疗有效降低心、脑血管病事件17项临床试验荟萃分析 071016a_Irbe GLB.IRB.07.10.11 Progression from Hypertension to HF Hypertension is identified as a precursor to HF in multiple epidemiologic studies and is the chief precursor to LVH identified by electrocardiogram. Hypertension with LVH and myocardial infarction may lead to loss of contractile tissue, which may progress to left ventricular diastolic dysfunction and LVSD. HF develops later in the cascade and results when other processes, such as neurohormonal activation become superimposed on ventricular dysfunction. After HF develops, overall prognosis may be bleak, often worse than that seen with some forms of cancer. Evidence suggests that interventions at the preclinical stages of the sequence of events leading to HF have the greatest impact on reducing morbidity and mortality associated with it. Reference: Vasan R, Levy D. The role of hypertension in the pathogenesis of heart failure: A clinical mechanistic overview. Arch Int Med. 1996;156:1789-1796. 1. McKee et al. N Engl J Med. 1971;285:1441-1446. 2. Levy D. JAMA 1996;275:1557-1562. Framingham 随访研究的资料显示，高血压 是心力衰竭发生的主要危险因素。 约90%的心力衰竭患者，在发生心力衰竭前 曾有高血压史。 140/90 140-159/90-99 160/100 BP (mm Hg) Lloyd-Jones et al. Circulation 2002;106: 3068-3072. 3343 men and 4199 women followed for 25 years – no HF at baseline Age Male Female Male Female Male Female 0 5 10 15 20 25 30 Lifetime risk (%) 40 years 80 years 60 years Years Normal LV Subclinical Clinical heart LV structure remodeling LV dysfunction failure function Heart failure Obesity Diabetes HTN Smoking Dyslipidemia Diabetes MI LVH Diastolic dysfunction Years/months Systolic dysfunction Death Vasan RS et al. Arch Intern Med. 1996;156:1789-1796. HTN = Hypertension MI = Myocardial Infarction LVH = Left ventricle hypertrophy 高血压如何进展到心力衰竭 因心力衰竭首次住院患者 左心室射血分数