《高血压-李勇》ppt课件.ppt

通过APCSC的调研数据可以看到，在澳洲（西方人为主）以及亚洲人群（中国人群为主）的数据显示，SBP越高，致死及非致死出血性卒中发生率越高，但是两个人群之间异致性有显著差异( P值=0.0002)，亚洲人群，随着SBP的增高，致死及非致死出血性卒中发生率更高，远高于澳洲人群（西方人群），这说明SBP对于亚洲人的脑卒中更相关，更敏感。 在收缩压与致死性冠心病方面的关系方面，收缩压每增加10mmHg；大洋洲人群的冠心病死亡率将+22%，而亚洲人群的死亡率为+31% ，人口异质性P=0.002。可见收缩压对亚洲人群冠心病事件的影响较西方人更为明显。 由此说明，对于东方人来讲：严格控制血压对降低冠心病的死亡尤为重要。 Epidemiologic data has established for some time that hypertensive patients are at an increased risk for developing CHD compared to their normotensive counterparts. Specifically, data from Framingham as well as others have shown that patients with BPs 140/90 mm Hg are 2-4x more likely to develop cardiovascular disease than patients with BPs 140/90 mm Hg. Additionally, data has shown that reductions in BP through intervention can significantly decrease the risk of a cardiovascular event in the hypertensive patient. 目前的高血压治疗指南设定的血压控制目标值为： - 在无并发症的患者中,将血压降至140/90mmHg以下； - 在某些情况下这一目标还是不够： 对糖尿病患者将血压降至较低水平(130/80 mHg)以下是有益的 肾功能受损患者，若蛋白尿超过 1g /日，应进一步降低血压 到125/75mmHg 以下。 Guidelines for ImprovingAdherence to Therapy Be aware of signs of nonadherence. Establish goal of therapy. Encourage a positive attitude about achieving goals. Educate patients about the disease and therapy. Maintain contact with patients. Encourage lifestyle modifications. Keep care inexpensive and simple. Guidelines for ImprovingAdherence to Therapy (continued) Integrate therapy into daily routine. Prescribe long-acting drugs. Adjust therapy to minimize adverse affects. Continue to add drugs systematically to meet goal. Consider using nurse case management. Utilize other health professionals. Try a new approach if current regime is inadequate. Hypertensive Emergencies and Urgencies Emergencies require immediate blood pressure reduction to prevent or limit target organ damage. Urgencies benefit from reducing blood pressure within a few hours. Elevated blood pressure alone rarely requires emergency therapy. Fast-acting drugs are available. Drugs Available forHypertensive Emer