高血压治疗中的热点问题.ppt

**JCN7指出：一级高血压伴有其他心血管危险因素者，持续10年SBP降低12mmHg，可防止每11名治疗患者中1名患者死亡。在合并CVD或TOD时，可预防没9名治疗患者中1名患者的死亡。********JNC7强调根据血压水平决定治疗：**利尿剂：**利尿剂：******原因在于—高血压是一种由心血管危险因素复合构成的综合征（高血压综合征，HypertensionSyndrome），是代谢综合征的一种特殊表现形式。＞80％的高血压患者合并有2－3个甚至更多的危险因素。因此，高血压不仅仅是血压水平的问题，更与多种心血管危险因素的综合作用密切相关，这就意味着高血压患者的治疗必须”全方位“出击……**可变的危险因素************Theinteraction相互作用ofmultipleriskfactorsmayleadtomultiplicative倍增的,ratherthanmerely仅仅additive,increasesinCVrisk.TheseVenndiagrams图解depict描绘theincreasesinriskassociatedwiththepresence出席ofmultipleCVriskfactorsin2hypothetical前提假说40-year-oldmalepatients,compared比较withtheCVDriskofa40-year-oldmalenonsmokerwithTC185mg/dLandSBP120mmHg,whoisnotglucoseintolerant不容忍的,andwhodoesnothaveLVH.TheVenndiagramontheleftillustratestheinteractionofriskfactorsinapatientwithmoderatelyelevatedTC(5.4mmol/L[210mg/dL]),hypertension(SBP165mmHg),andglucoseintolerance.Whileeachriskfactoraloneresultsina1.3-to1.9-foldincreaseinCVDrisk,theinteractionofall3riskfactorsresultsina4.5-fold倍increaseinCVDrisk.TheVenndiagramontherightshowstheinteractionofriskfactorsinapatientwithelevatedTC(6.1mmol/L[235mg/dL])andseverehypertension(SBP195mmHg)andwhosmokes.Eachindividualriskfactorresultsina1.6-to3.0-foldincreaseinCVDrisk.However,thepresenceofall3riskfactorsresultsinan8.7-foldincreaseinrisk.****Fivemajormorbidityandmortalitystatinstudiesinprimaryorsecondarypreventionpopulationshavebeencompleted.

Thispyramidranksthestudiesaccordingtothetypeofpatientsthatwereincludedineachstudy.ItbeginswithAFCAPS/TexCAPS,aprimarypreventionstudyinpatientsatlowriskofCHDandmovestoasmallergroupofhigh-riskCHDpatientsin4S,asecondarypreventionstudy.

Inbetweenthetwoextremes,coveringthemajorityofpatientswithand