高血压合理用药最新要点及处方课件.pptx

高血压合理用药最新要点讨论及处方分析;;高血压与心脏损害;高血压与脑血管损害;我国高血压患病率愈来愈高;6.1 ％ ~8%;降压本身的益处; 美国;中国高血压人群的临床特点;降低心脑血管事件是降压治疗的根本目的;2009中国高血压指南（基层版）要点;1、高血压治疗四大目标 ;何时开始用药 (2009,oct ESH Reappraisal) it appears reasonable to recommend that, in grade 1 hypertensives (SBP 140–159mmHg or DPB 90–99mmHg) at low and moderate risk, drug therapy should be started after a suitable period with lifestyle changes. Prompter initiation of treatment is advisable if grade 1 hypertension is associated with a high level of risk, or if hypertension is grade 2 or 3. 立即用药：a）2或3级高血压; b）1级HT +高危 改善生活方式后用药：1级HT +低、中危 ;亚临床靶器官损害之保护 (2009,oct ESH Reappraisal) Evidence on the important prognostic role of subclinical organ damage continues to grow. In both hypertensive patients and the general population, the presence of electrocardiographic and echocardiographic LVH, a carotid plaque or thickening, an increased arterial stiffness, a reduced eGFR (assessed by the MDRD formula), or microalbuminuria or proteinuria substantially increases the total cardiovascular risk, usually moving hypertensive patients into the high absolute risk range. 合并亚临床靶器官损害常为高危者：LVH,颈动脉斑块、增厚硬化， eGFR下降，微量/蛋白尿。 ----Journal of Hypertension 2009, 27:2121–2158;血压目标 所有患者 140/90 140/90 DM/肾病 130/80(DM) 130/80 冠心病：130/80 mm Hg (2007/2009年欧洲高血压指南) *老年SBP难于140可适当灵活些(尤低危者)， 老年收缩压可降至150 mm Hg以下 ;血压目标 ——低限？ (ESH June, 2009 ) Key among the changes will be the recommendation of a lower threshold level--around 120 mm Hg systolic and 70 mm Hg diastolic--below which it could be dangerous to reduce blood pressure in high-risk individuals, representing the so-called J-curve phenomenon, Mancia said. J-Curve: A Narrow Window of Optimum BP for High-Risk Individuals “J形曲线”可能存在，有些特定高危患者血压不宜过低（120/70） ----June 16, 2009 (Milan, Italy) — The European Society of Hypertension (ESH);2、治疗策略（中国） 几周内渐降血压至目标, 更长/更短期间？（几天？） 推荐长效剂，持续24小时、T/P50%{药物谷峰比值(T／P)=降压药疗效最低时血压下降值／降压药疗效最大时血压下降值，T／P可以反映降压药疗效持续时间长短，比值越高表明药物作用越持久。国家药品