联合降压药物治疗与其药物选择钙拮抗剂价值.pptVIP

联合降压药物治疗与其药物选择钙拮抗剂价值 P for heterogeneity = 0.002澳洲亚洲Hazard ratio+10 mmHg: 1.22 (1.18-1.26)+10 mmHg: 1.31 (1.26-1.35)Mean usual SBP (mmHgl)收缩压与冠心病事件 收缩压与致死及非致死缺血性卒中P for heterogeneity = 0.001澳洲亚洲+10 mmHg: 1.24 (1.15-1.35)+10 mmHg: 1.53 (1.48-1.59) Hazard ratioMean usual SBP (mmHgl) 110120130140150160170 1101201301401501601700.51.02.04.08.00.51.02.04.08.0 0306090120150198519901995200020052010 (年)脑血管病冠心病标化死亡率(1/10万)CV死亡率呈上升趋势CHD为第二位CV死因冠心病: 中国人群死亡重要原因在中国，高血压是冠心病的重要危险因素高血压导致心血管病的相对危险高达3-4倍在总的CV事件中，23.7%的急性冠心病事件归因于高血压CHD死亡48%《中国心血管病报告2005》2004年城市居民CHD死亡占所有心脏病死亡的48% Stroke and MI in Hypertension Trials1. Kjeldsen SE et al. Blood Pressure 2001;10:190-192. 2. Dalh?f B et al. Lancet 2002;359:995-1003. 3. Wing LMH et al. N Engl J Med 2003;348:583-592. 5012345678STOP-1SHEPSTONESYST-EURSYST-CHINAHOTCAPPPSTOP-2NICSNORDILINSIGHTPercentage of patients with eventStrokeMyocardial InfarctionPercentage of fatal and nonfatal strokes, and fatal and nonfatal MIs reported in large, prospective hypertension trials published after 1990.LIFEANBP2 高血压患者脑卒中/心肌梗死发病率STONE 8.0Syst-China 8.7NICS-EH 4.0SHEP 1.2MRC II 0.8STOP-II 1.2Syst-Eur 1.7 抗高血压治疗效果%降低MacMahon SW et al. Prog Cardiovasc Dis. 1986;29(suppl 1):99–118.605040302010048%16%脑血管疾病冠心病 不同年龄的缺血性心脏病风险与血压关系Lewington et al. Lancet. 2002;360:1903-1913.40-49 years50-59 years60-69 years70-79 years80-89 years收缩压Age at risk:IHD Mortality(Floating Absolute Risk and 95% CI)2561286432168421120140160180Usual SBP (mm Hg)舒张压IHD Mortality(Floating Absolute Risk and 95% CI)2561286432168421708090100110Usual DBP (mm Hg)Age at risk:40-49 years50-59 years60-69 years70-79 years80-89 yearsLower Is Better 至少将血压降至 SBP 140mmHg 和 DBP 90mmHg 对糖尿病患者 SBP 130mmHg 和 DBP 80mmHg 对老年人SBP 150mmHg和 DBP 90mmHg 仍然强调严格控制血压降压治疗的目标中国高血压指南2004 高血压药物治疗的目的 减少总的心血管病死率和病残率，而不仅仅是降低血压抗高血压治疗的策略降压达标是手段，靶器官保护是关键 治疗后血压水平与冠心病进展Sipahi I, et al. JACC Vol. 48, No. 4, 2006 BP Differences of 2 mmHg Are Associated With Up to a 40% Effect on CV Risk Meta-analysis of 61 prospe