hypertension(04本科内科学-邓利芝2007年9月).pptVIP

Question 高血压的概念或标准是什么？ 高血压有哪些危险因素？ 高血压的靶器官包括哪些？有哪些危害？ 引起继发性高血压的常见原因有哪些？ 高血压治疗的目标血压是多少？ 一旦诊断为高血压，是否立即服用降压药？ 非药物治疗包括哪些？ 降压药物治疗原则 常用抗高血压药物（一线用药）有哪几类？其代表药物是什么？ Definition and Classification Hypertensive Standard（高血压标准）: SBP 140MmHg and /or DBP 90mmHg Chinese guideline(WHO/ISH 2005) 条件（前提）： 1. 18YS 2.安静状态下 3.未服用降压药 Epidemiology（与美国对比） China China U.S.A 91’(15y)? 02’ 2000’18y Incidence 11.88% 18.88% 20% Awareness 26.3% 30.2% 70% Treatment rates 12.1% 24.7% 59% Control rates 2.8% 6.2% 34% Risk factor of hypertension multiple Unchangeable: Age，sex (gender) ，family history Changeable: Lifestyle diet ( Na↑, K↓, Ca↓ ) overweight or obese lack of exercise, and anxiety ☆Harmfulness of target organ Heart: Left ventricular hypertrophy( ECG,UCG,Xray) Coronary artery disease(CAD) Atrial fibrillation(Af) Heart failure UCG-LVH Central nervous system Kidneys Cr Male：115-133 ?mol/L Famel：107~124?mol/L micro-album ：30-300mg/24h Harmfulness of target organ(2) Retina: Blood vessels: Aortic aneurysm（主动脉瘤）, aortic dissection（主动脉夹层）. Carotid artery medium颈动脉壁厚 0.9mm. B－型超声：颈动脉测量部位 Approach to newly diagnosed hypertension(新病例诊断步骤) To obtain accurate and representative measurement of BP（获得真实的血压值）. To identify any underlying cause (识别继发性高血压secondary HT) To recognize other risk factor and to detect any complications (target organ damage, TOD)（寻找危险因素，及时发现并发症，如靶器官损害） History（病史） family（家族史） and clinical（临床病史） 1. Bp level and hypertensive course 2.Risk factor: family history of HT, CVD, DM hyperlipidaemia, Obese, DM lifestyle (Lack of exercise, diet, smoking , Drinking）. History: family and clinical 3.TOD symptom（靶器官症状）: Headache头疼, dizziness头晕, TIA等, palpitation心悸 , out of breathe呼吸困难, Angina pectoris 心绞痛等 4.Antihypertension history: drug effective side effect Examination（体查） Accurate Measurement BP