冠心病的高血压.pptVIP

冠心病合并高血压治疗—目标降压值武警医学院附属医院冠心病一般预防应将血压治疗目标值设为140/90mmHg以下。高血压合并冠心病的患者,降压治疗应缓慢进行;舒张压(DBP)不应降得太低,不宜低于60mmHg;降压治疗的起始与目标血压在大多数患者为130/80mmHg,对合并左心室功能不全的患者,可将血压降到120/80mmHg。老年高血压脉压宽，降低SBP时可能导致极低DBP值(60mmHg)。临床医师应留心仔细地评估任何不适征兆，尤其是那些由心肌缺血导致的症状或体征。各国最新指南比较武警医学院附属医院ACS合并高血压管理武警医学院附属医院初始应进行抗凝和抗血小板治疗，同时调节心肌氧的供需之间平衡。01治疗目的：02减少梗死心肌的坏死面积03预防主要心脏性并发症的发生04防治室颤（VF）的发生05ACS合并高血压管理武警医学院附属医院增加冠状动脉血流减少心脑血管不良事件靶器官的保护血压控制的策略降低心肌耗氧，减轻心脏负荷不增加心率，不增加心肌收缩力Compensationmechanismtamper调版式Abstract—Toevaluatetheriskofcardiovasculardisease(CVD)mortalityinhypertensivemenaccordingtothepresenceofassociatedriskfactors(ARFs).Thepopulationwascomposedof29640normotensivemenwithoutARFs(referencegroup)and60343hypertensivemen(withandwithoutARFs)whohadastandardhealthcheckupattheCentred’InvestigationsPréventivesetCliniquesbetween1978and1988.Mortalitydataforameanperiodof14yearswereanalyzed.ThefollowingARFswereconsidered:totalcholesterol$2.5g/L,personalhistoryofdiabetes,smoking(currentsmokers),bodymassindex.28kg/m2,andheartrate.80bpm.CVDriskrelatedtothepresenceofisolatedhypertension(assessedinhypertensivesubjectswithoutARFsversusthereferencegroup)increasedlinearlyfrom15%attheageof30yearsto134%attheageof80years.Inhypertensivesubjects,oneadditionalARFincreasedCVDriskby56%(47%to65%,P,0.01)inyoungersubjectsbutonlyby4%(28%to17%,P5NS)inoldersubjects.TheroleofhypercholesterolemiaandtobaccosmokinginCVDmortalitywassignificantlyhigherinhypertensivesubjectsaged,55yearsthaninhypertensivesubjectsaged$55years(P,0.01),whereastherolesoftachycardiaandobesitywerenotaffectedbyage.Inyoungerhypertensivesubjects,evaluationofCVDriskandtherapeuticstrategiesshouldtargetARFs.Inoldersubjects,thepresenceofhighbloodpressurelevelsseemstobethemajordeterminantofCVDrisk.Themainc