糖尿病患者的血压管理穆淑霞课件.ppt

2010版中国高血压防治指南强调：血管指标是独立于血压的心血管事件预测因素 颈动脉内中膜厚度（IMT）和粥样斑块可独立于血压水平预测心血管事件 脉搏波传导速度（PWV）增快是心血管事件的独立预测因素 IMT 内中膜厚度的五分位数 颈动脉IMT是心脑血管事件的重要指标 脑卒中的发生与颈动脉内中膜厚度(CIMT)密切相关 每千人年心梗或卒中比率（%） New England Journal of Medicine, 1999;340:14-22 Laura Tripkovic, Kathryn Hart. Summer Meeting 30 June–3 July 2008 PWV可以反映血管内皮及动脉僵硬度的变化 测量PWV PWV PWV可评估大动脉的弹性及硬度，是心血管事件的独立危险因素 PWV(m/s)=L/ t （两个压力记录部位之间脉搏波传导距离 / 传导时间） PWV反映测量两点间的动脉节段弹性，动脉弹性降低，则PWV增加 颈-股 PWV 肱-踝 PWV 小 结 糖尿病血压管理 Thank you ! 谢谢！再见！ 階瞰勵嶺懂擋擔據撿激濃燭瞳璐磯磷績聯膠膛臨舉蓮蔗蔣講遞輾鍍鍛鍾鍵隆隊駿黛點澤灃潞澄優嬰嶼獄贏應憶擁澳營蔚蔭輿鍰闈陽償擇擅操澤澡燧禧穗簇縱 嬪彌幫檜篷縫繁褒錨韓蔓征擘扶十八畫櫃壙歸繢蕢磬纊戴擬抬擠爵濤禮簡糧職舊蕉謹轉遮題鎮儲藜芷遲鯉翼芸謳醫隘額璦蕕鎰隗彝濰儲叢曙濕織蕭蕊蟬瑞適雙繡鎖壘 璧馥十九畫擴關鏗廬疆禱薦勒襟譚證轎遼鄰鄭鄧類鯨麗麓鏡覺際櫓櫟濼轔鏈韻穩薏薇膺臆蟻襖遺霧願豔蕷蕹韞璽薛薪繩蟹識贊遵遷選龐瀋薦譙旋鏘鏃鏟際顙鶉暹攀簿梵薈鎘嘎灌尐鼓祚胙怍嘬唑阼鳟罇撙蕞躦纘攥鏃菹俎鯫騶鄹陬諏糉腙傯髭鯔齜訾觜趑粢笫耔秭錙眥恣貲輜梓緇孳嵫諮镯斫禚焯濯涿浞擢諑倬窀肫縋騅惴僮顓饌囀麈躅翥舳筯竺瘃疰銖炷櫫櫧杼瀦渚洙茱邾侏伫酎籀碡胄縐紂妯啁荮踵舯螽锺塚觶豸踯躓蹠酯縶蛭痣鷙雉黹祗 对于糖尿病患者来说，血压的降低意味着什么呢？ 我们前面提到的UKPDS研究结果表明：血压每下降10mmHg，所有糖尿病相关终点风险降低12%，总死亡率下降12%，糖尿病相关死亡风险降低17%。不得不说血压的降低为糖尿病高血压患者带来的获益是巨大的。 Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study Amanda I Adler, Irene M Stratton, H Andrew W Neil, John S Yudkin, David R Matthews, Carole A Cull, Alex D Wright, Robert C Turner, Rury R Holman on behalf of the UK Prospective Diabetes Study Group Abstract Objective To determine the relation between systolic blood pressure over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes. Design Prospective observational study. Setting 23 hospital based clinics in England, Scotland, and Northern Ireland. Participants 4801 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk. Outcome measures Primary predefined aggregate clinical outcomes: any complications or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarc