2010高血压指南亮点——H型高血压1.pptVIP

《中国高血压防治指南2010》中国亮点 H型高血压在中国;内容提要;新指南相关原文征引;“H型”高血压 H-type Hypertension;H型高血压在中国的特殊意义;内容提要;;Hcy病理作用;多项大型流行病学研究荟萃分析血浆Hcy增加5μmol/L，脑卒中风险增加59%;JANA.2004；7；11-24;2006美国卒中指南定义HCY超过10μmol/L为高同型半胱氨酸血症（HHCY）;H型高血压—心脑血管疾病极高危危险因素;H型高血压—心脑血管疾病极高危危险因素;H-型高血压发生率 H-type Hypertension;全球40年一级证据RCT研究：Meta分析确认叶酸降Hcy预防脑卒中有效;In a meta-analysis of clinical trials evaluating the efficacy of folate supplementation for stroke prevention, folate was associated with an 18% reduction (RR, 0.82; 95% CI, 0.68 to 1.00; P0.045) in primary stroke risk. 378 supplementation also appeared to be beneficial for stroke prevention in patients receiving folate for 36 months, cases with 20% reduction in homocysteine, and in populations without folate grain supplementation.;;内容提要; ;J Med Genet 2003;40:619-25 Acta Universitatis Medicinalis Anhui 2006;41:639-42;;MTHFR基因型、血浆Hcy水平与脑卒中风险的剂量反应图;内容提要;高血压患者往往同时存在多个心血管危险组分。除了针对某一危险因素组分进行干预外，更应强调综合干预多种危险组分。综合干预有利于全面控制心血管危险因素，有利于及早预防心血管病。 ; Unadjusted Adjusted BP response Genotype TT genotype TT genotype Tertiles Mean+SD CC+CT TT OR ( 95%CI) p OR (95%CI) p ?DBP Lower -1.58?2.13 121 18 1.0 1.0 Middle 4.49?1.74 106 41 2.6 (1.4-4.9) 0.003 2.6 (1.3-5.1) 0.005 Upper 12.04?3.26 111 47 2.8 (1.5-5.2) 0.001 2.5 (1.3-4.7) 0.006 ;高HCY经NO-H2S-ACE偶联增加血管应激-高血压;ACEI/叶酸组方进一步降低心脑血管事件19% ;Arch Intern Med. 2001;161:695-700 BMJ.1998; 316; 894-898;降hcy减少脑卒中风险的最佳方案; 依叶?：科学组方、个体化治疗; ; 依叶?：全面阻击H型高血压;内容提要;Lancet. 2011 August 13; 378(9791): 584–594.;柳叶刀最新荟萃分析再次证实中国干预Hcy的必要性;H型高血压临床研究的国际领先性;中国脑卒中一级预防研究China Stroke Primary Prevention Trial(CSPPT)Enalapril Maleate and Folic Acid Tablets for Primary Prevention of Stroke in Chinese Hy