(精选)【高血压英文课件精品课件】 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)教学课件.pptVIP

Goals of Treatment In hypertensive patients, the primary goal of treatment is to achieve maximum reduction in the long-term total risk of cardiovascular disease This requires treatment of the raised BP per se as well as of all associated reversible risk factors BP should be reduces to at least below 140/90 mmHg (systolic/diastolic) and to lower values, if tolerated, in all hypertensive patients Goals of Treatment Target BP should be at least 130/80 mmHg in diabetics and in high or very high risk patients, such as those with associated clinical conditions (stroke, myocardial infarction, renal dysfunction, proteinuria) Despite use of combination treatment, reducing SBP to 140 mmHg may be difficult and more so if the target is a reduction to 130 mmHg. Additional difficulties should be expected in elderly and diabetic patients and, in general, in patients with CV damage In order to more easily achieve goal BP, antihypertensive treatment should be initiated before significant cardiovascular damage develops Monotherapy versus combination strategies Choose between If goal BP not achieved If goal BP not achieved Previous agent at full dose Switch to different agent at low dose Previous combination at full dose Add a third drug at low dose Two-to three-drug combination at full dose Full dose monotherapy Two-three drug combination at full doses Mild BP elevation Low/moderate CV risk Conventional BP target Marked BP elevation High/very CV high risk Lower BP target Single agent at low dose Two-drug combination at low dose Thiazide diuretics ACE inhibitors β-blockers Angiotensin receptor antagonists Calcium antagonists α- blockers The preferred combinations in the general hypertensive population are represented as thick lines. The frames indicate classes of agents proven to be beneficial in controlled intervention trials Possible combinations between some classes of antihypertensive drugs Antihypertensive Treatment in Diabetics Where applicable, intense non-pharmacological m