河南省人民医院高血压科赵海鹰.pptxVIP

会计学;特 点;;七个流程;第一步 （Step one）定义是否准确;;排除假性难治性高血压Exclude Pseudoresistance;血压测量不准确;;Franminghanm研究60-70%的高血压病人有肥胖，并随年龄增加。 在高血压肥胖病人中75%不限盐饮食，当体重减轻10kg血压达正常。 肥胖高血压病人减肥比限盐更重要;obesity is a common feature of patients with resistant hypertension. Mechanisms of obesity-induced hypertension are complex and not fully elucidated but include impaired sodium excretion, increased sympathetic nervous system activity, and activation of the renin-angiotensin-aldosterone system.;体力活动与血压;Dietary Approaches Stop Hypertension饮食控制终止高血压;高盐 高胆固醇 高脂肪 低钾 低钙 低镁 低膳食纤维 低优质蛋白 ;;甘草长期服用可引起血压升高机制明确;;OSAS与高血压关系;原醛的筛查;原醛患病率高;原醛筛查必要性;原醛的疑惑;How frequent is hypokalemia in PA? In recent studies, only a minority of patients with PA (9–37%) had hypokalemia . Thus, normokalemic hypertension constitutes the most common presentation of the disease, with hypokalemia probably present in only the more severe cases. Half the patients with an APA and 17% of those with idiopathic hyperaldosteronism (IHA) had serum potassium concentrations less than 3.5 mmol/liter. Thus, the presence of hypokalemia has low sensitivity and specificity and a low positive predictive value for the diagnosis of PA. ;醛固酮可以不升高;影响肾素因素较多;ARR比值;肾上腺囊肿;原发性醛固酮增多症;;手术效果差与术前未确 定性质直接相关;肾动脉狭窄;肾动脉狭窄临床诊断方法;;第33页/共53页;第34页/共53页;The best screening test for pheochromocytoma is plasma free metanephrines (normetanephrine and metanephrine), which carries a 99% sensitivity and an 89% specificity.;;;;;神经精神因素;血压发作性升高;继发性检查;;利尿剂的使用;增加利尿剂的剂量或据肾功能改变利尿剂的类型 In patients with underlying CKD (creatinine clearance 30 mL/min), loop diuretics may be necessary for effective volume and blood pressure control.;两种药物的联合;三种药物的联合;三种药物的联合;;有回顾性研究资料显示： 顽固性高血压转至高血压专科随访一年血压下降18/9mmHg,血压控制率由18%提高至52%;In a separate retrospective analysis, hypertension specialists at the Rush University Hypertension Center were able to control blood pressure to 140/90 mm Hg in 53% of patients referred for resistant hypertension;谢 谢