解析中国高血压指南再认识卒中血压管理策略.pptVIP

在刚刚结束的2010年欧洲卒中大会的“高血压与脑”分论坛上，卒中患者脉压与卒中复发和预后的相关性成为学者们关注的焦点。多项研究显示，脉压增加与卒中患者预后不良相关。 * 稳定的正常血压：每次随访SBP、DBP≤140 mmHg 发作的中度高血压：至少一次BP≤140 mmHg，至少一次BP140 mmHg,但是均180 mmHg 发作的重度高血压：至少一次BP≤140 mmHg，并且至少一次BP≥180 mmHg 稳定的高血压：所有随访BP140 mmHg * UK-TIA试验为一项随机、双盲试验，在1979~1985年之间，共纳入2435例近期TIA或缺血性卒中的患者。对该试验入选的2006例TIA患者，在发生卒中或死亡前平均随访10次。研究结果显示，随着血压变异性（SD SBP）的增加，患者的卒中风险显著增加。从这张图表可以看到，收缩压标准差位于十分位数最高位的患者，其发生卒中的风险是标准差处最低位患者的6.22倍。由此可见，血压变异性是卒中风险的强预测因子。 * Types of Morning Hypertension For patients with high BP, this circadian pattern is no different but may be associated with poor health outcomes. In patients with hypertension, BP follows a nadir occurring during the nighttime hours and a surge occurring during the early morning period (6 AM-12 PM). This phenomenon is referred to as morning hypertension. Two types of morning hypertension exist. Patients who demonstrate persistently high BP from nighttime to morning are referred to as nondippers, as their BP remains elevated nocturnally. The second type is morning surge hypertension (MSH), which is associated in part with the extreme dips of nocturnal BP. For these hypertensive patients, their nighttime BP is 20% lower than their daytime BP. 1.Hoshide S, Kario K, Hoshide Y, et al. Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives. Am J Hypertens. 2003;16:434-438. 2.Kario K, Yasui N, Yokoi H. Ambulatory blood pressure monitoring for cardiovascular medicine. IEEE Eng Med Biol Mag. 2003;22:81-88. 3.Kario K, Shimada K, Pickering TG. Abnormal nocturnal blood pressure falls in elderly hypertension: clinical significance and determinants. J Cardiovasc Pharmacol. 2003;41 Suppl 1:S61-66. 对于卒中二级预防降压药物实践选择原则，2006AHA/ASA从药物降压作用、降压外作用及循证医学证据、患者病理基础和依从性方面综合考虑，归纳了6点：首先是降压作用（降压须达标： 130/80mmHg，平稳且持久；而对于单药无法达标，或血压≥160/100者应采用联合降压，其次是降压外作用（包括降压外的额外获益:抗动脉粥样硬化作用和靶器官保护）；是否有充分的循证医学证据支持，考虑患者是否伴随内科疾病，有无血管狭窄，低灌注。同时还应兼顾服用方便，耐受性好，经济承受能力等因素，以保证患者有良好