优化降压治疗策略.pptVIP

心血管危险分层及靶器官损伤筛查 除2007年指南推荐采用低度危险、中度危险、高度危险及极高度危险外，新指南更强调对所有靶器官损伤的筛查及对预后有特殊意义的OD随访中复查，比如用心脏彩超证实ECG疑诊的LVH、所有患者计算eGFR并进行CKD分期等。 Implication:氯沙坦在高血压合并LVH、高血压合并CKD、高血压合并蛋白尿的患者中循证具有优势，新版指南的普及有助于提高医生对这些患者的识别。 * Data taken from European cardiovascular disease statistics 2008 一些研究表明，治疗过程中发生的无症状性靶器官损害逆转可以反映治疗所带来的发病及致死性心血管事件的减少，因而能够提供所采用的治疗策略对患者的保护是否更有效的有价值信息。这在降压治疗所获得的心电图诊断的LVH 逆转( 电压标准或劳损标准)、超声心动图诊断的LVH 逆转以及超声心动图检查结果计算的LVM 和左心房扩大的改善都已经得到了很好的证明[150,151,261,684–686]。 《中国高血压防治指南》培训手册 * 国外报导2－10％慢性高血压病人有LVH心电图证据，50％符合超声心动图诊断标准，国内约30％符合UCG诊断标准 Slide 29 左室肥厚的高血压患者与普通高血压患者在脑血管事件中的研究 这个研究试图确认左室肥厚的初期轻微高血压患者是否会增加脑血管病发病风险。 A total of 2363 hypertensive patients (mean age 51 years, 47% women) 一共有2363名高血压患者（平均年龄51岁，女性占47%）free of prior 心血管病were followed for up to 14 years (平均5年). At entry, the prevalence of LVH by ECG (Perugia score) was 17.6% and by echocardiography (LVM 125 g/m2), 23.7%.41 During follow-up, 105 patients experienced a first stroke or TIA. The cerebrovascular event rate was higher among those patients with LVH at entry, diagnosed by ECG or echocardiography, than among those without hypertrophy (both p0.001). The association between LVH diagnosed by ECG or echocardiography and subsequent cerebrovascular events was independent of multiple risk markers, including age, gender, presence of diabetes, and 24-hour mean BP.41 The authors concluded that in patients with essential hypertension who were apparently healthy at baseline, LVH conferred an excess risk of stroke and TIA, independent of blood pressure and other risk factors.41 This slides shows the change in microalbuminuria (MAU) as a predictor of cardiovascular (CV) and renaloutcomes in patients with vascular disease in the ONTARGET study Analyses were performed (N=23,480) and adjusted for age, gender, BMI, smoking, alcohol consumption, eGFR, plasma glucose, blood pressure (BP) and HR at baseline, BP change within 2 years and baseline albuminuria. The risk of CV and renal outcomes increases significantly if MAU is