高血压的诊断和个体化药物治疗.ppt

* 注意：不同年龄段、不同臂围的患者宜选用不同大小的袖带。 * * 腰围：腰围平面经过脐与剑突连线的中点，以及肋弓最低点与髂骨连线的中点。 * Slide 7: Angiotensin II Plays a Central Role in Organ Damage In adult tissues, virtually all known deleterious effects of angiotensin II (A II) ? the end product of the renin-angiotensin system ? are attributable to the AT1 receptor.21 The adverse cerebral and cardiovascular effects of A II, which have potentially lethal sequelae, are pervasive. Preclinical data implicate A II in cerebro-vascular ischaemia through the development of atherosclerosis.22 By potentiating the activity of other neurohormonal systems, A II exerts harmful cardiovascular effects by means of the AT1 receptor 23 ? including vasoconstriction,23 vascular hypertrophy,24 left ventricular hypertrophy,24 myocardial and vascular wall fibrosis,23 myocardial remodeling24 and cardiac myocyte apoptosis under some conditions25? and thereby contributes to the development of hypertension, heart failure, and myocardial infarction.21,25 A II also plays a central role in the development of renal insufficiency in response to heart failure. As cardiac function deteriorates, decreased renal blood flow leads to a reduced glomerular filtration rate.26 Intense sympathetic activation in heart failure stimulates production of A II in the kidney 26 that initiates a cascade of potentially deleterious renal effects including proteinuria,27 increased aldosterone release,21,26 and cell growth and matrix accumulation leading to glomerular sclerosis.28 * 小剂量开始：任何一种药物都应从小剂量开始，尤其是老年人，以减少不良反应。如果患者对单一药物有较好反应，但血压未能达到目标，应当在患者能够很好耐受的情况下增加该药物的剂量或联合用药。 终身治疗，避免频繁换药：高血压不可治愈，应强调终身治疗，对此，人们依旧认识不足。在治疗过程中不要频繁更换药物。但如果患者耐受性差，或用药4-6周后疗效反应很差，可换用另一种药物。 联合用药，兼顾合并症：合理的联合用药可以最大程度地降低血压，同时使不良反应减至最低限度，通常宜加用小剂量的二种或两种以上抗高血压药物。用药时，还要兼顾患者并存的危险因素与相关疾病。 24小时平稳降压：尽可能使用一天一次的具有24小时降压疗效的长效药物。 个体化治疗: 治疗强调个体差别，因人而异。兼顾并存的相关疾病及其他危险因素。 * 按流程讲述。 * 上述药物均为安全有效的一线抗高血压药物。 * 除篇中内容外，还应强调： 鉴于其价格便宜、疗效肯定，更适于基层应用； 其不良反应与使用剂量直接相关。 * 双氢克尿噻在此推荐剂量下应用，不良反应发生率较低； 应用吲哒帕胺时，尤应注意低钾血症的发生； 螺内酯主要适应症为醛固酮水平升高的患