Hypertension_ Improving Treatment and Control - Heart Disease ...课件.ppt

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Hypertension_ Improving Treatment and Control - Heart Disease ...课件.ppt

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Hypertension_ Improving Treatment and Control - Heart Disease ...课件

Improving Blood Pressure Treatment in the Community: Implications of the JNC7 Recommendations and ALLHAT Results Nathan D. Wong, PhD, FACCProfessor and DirectorHeart Disease Prevention ProgramUniversity of California, Irvine Hypertension: A Significant CV and Renal Disease Risk Factor At Least 65 Million Americans Require Treatment for Hypertension Risk of Cardiovascular Events by Hypertensive Status SBP-Associated Risks: MRFIT Elevated SBP Alone Is Associated With Increased Risk of Cardiovascular and Renal Disease Disease Relative Risk Kidney failure (ESRD) ?2.8 Stroke ?2.7 Heart failure ?1.5 Peripheral vascular disease ?1.8 Myocardial infarction* =1.6 Coronary artery disease ?1.5 Prevalence, Awareness, Treatment, and Control of Hypertension in US Adults 2003-2004 (Ong et al., Hypertension 2007; 49: 69-75) Prevalence (%) of HTN in US Adults, by Disease Status (Wong et al, Arch Intern Med 2007, in press) Treatment (%) of HTN in US Adults, by Disease Status (Wong et al., Arch Intern Med 2007, in press) Control (all treated) (%) of HTN in US Adults, by Disease Status (Wong et al., Arch Intern Med 2007, in press) Blood Pressure Classification 4-Year Progression To Hypertension: The Framingham Heart Study HOT Study: Significant Benefit FromIntensive Treatment in the Diabetic Subgroup Benefits of Lowering BP Preventable CHD Events from Control of Hypertension in US Adults(Wong et al., Am Heart J 2003; 145: 888-95) Randomized Designof ALLHAT Baseline Characteristicsand Follow-up Doxazosin Arm Terminated Early Futility of finding a significant difference for primary CHD outcome Statistically significant 20 percent higher rate of major secondary endpoint, combined CVD outcomes (80% higher rate of heart failure) Subgroup Comparisons Results were consistent across age, race, gender, and baseline diabetes subgroups, except: Stroke Black L/C RR (95% CI) = 1.40 (1.17 – 1.68) Non-Black L/C RR (95% CI) = 1.00 (0.85 – 1.17) Combined CVD Black L/C RR (95% CI) = 1.1