优化联合降压 -- 降压达标与靶器官保护的必由之路
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优化联合降压 -- 降压达标与靶器官保护的必由之路. 降压治疗策略的 发展与变迁. 降压获益证据. 联合治疗 , 血压控制达标. 优化治疗方案. 高血压的危害. 脑卒中最重要的危险因素 收缩压每升高 10mmHg 脑卒中增加 50% 舒张压每升高 5mmHg 脑卒中增加 46% 冠心病的危险因素 收缩压在 120--139mmHg 比 < 120mmHg 者增加40% 增加心力衰竭和肾脏疾病的危险 心力衰竭危险性高 6 倍 舒张压每降低 5mmHg ESRD 危险减少 25%. - PowerPoint PPT PresentationTRANSCRIPT
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,
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10mmHg50% 5mmHg46%120--139mmHg < 120mmHg40%6 5mmHgESRD25%
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Epidemiology of CVD risk factors in the Asia Pacific region
20036APCSC---.
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Studies currently in APCSC
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()500,81998,790% 33.745.7 ()-45.053.2-9.514.4-20-10720-104APCSC
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P = 0.001+10 mmHg: 1.24 (1.15-1.35)+10 mmHg:+24%+10 mmHg: 1.53 (1.48-1.59)+10 mmHg: +53 %
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P = 0.0002Hazard ratio+10 mmHg: 1.20 (1.04-1.35)+10 mmHg:+20%+10 mmHg: 1.70 (1.64-1.76)+10 mmHg:+70%Mean usual SBP (mmHgl)
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CHDCVDCVDLancet 2003;362:1527-45
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2006: Treat to goal
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mmHg
140/90 130/80 130/80
140/ 90 130/ 80
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II
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AT
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Glagovs (Progression)Source: Glagov et al., N Engl J Med, 1987. REVERSAL)
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40%-60%
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10mmHg (Rule of TENS)10mmHgWeir, M. 4th annual Diovan International Symposium Feb 2003. Seville, Spain
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, 2004. 32(4)291-29470%
Chart1
17.28
44.15
28.27
10.31
Percentage of Patients(%)
Sheet1
123
17.2844.1528.2710.31
- AASKMAP
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1) 220/10mmHg2JNC 72) 2005Chobanian AV, et al. JNC 7 report. JAMA.2003;289:2560-72. 2003 ESH/ESC Hypertension Guidelines. Journal of Hypertension 2003; 21:1779-1786
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ACECCBARB
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35%-40% 20%-25% 50%
110SBP10mmHg, 101 JNC-7
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3140/90mmHg
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---BHSAAMI2/35DMSBPDBPIVDBP1-225mg3
- ---BHSAAMI10%~15%24h
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---
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mmHg 1 2 3 SBP 140-159 160-179 180 DBP 90-99 100-109 110 1-2 3
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Bp140-180/90-110 mmHg 1-2HTN 3-63-12 Bp140/90Bp140/90 Bp140/90 p140/90
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1.
,
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2.
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3. ()
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ISH,
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4. ACEI
5. AT II
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ARBACEIACEI 1DM
ARB LVH,
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6.
1~16mg
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BB TG II-IIIAVBIDM
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ACEIK AKDM
ATIIACEI ACEI
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AVB
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140/90mmHg 130/85mmHg 130/80mmHg >1g/24h 125/75mmHg 150mmHg
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,1 ACEI2 3 4 ACEIARBCCB
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: ACEI/ARB+CCB+ACEI/ARB
: ARB/ACEI+-
: +-+ACEI/ARB : -+ CCB + ACEI
: ACEI/ARB +-
: -+ CCB
: CCB + ACEI1
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: ACEI+ARB+CCB
: CCB+, CCB+ACEI, ACEI/ARB+
: ACEI/ARB + CCB : CCB+ : CCB+ACEI/-B+: +CCB+ ACEI +-B -B+2
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ACEI/ARB -
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(ISH) ()TODACC, , (,) (,) ACEI(ARBs)
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(4) X (X1/2)
ACEI CCBs (-13.3) (-9.3) (-6.8) (-5.5)
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1
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CCB10mgq6hq8h10mgq6hq8h 30mg qd -2550mgq12h 2550mgtid 25mgqd 0.250.5mgBid Qid 2550mgq12hPO5mg, ACEIARB 2
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,, , ACEI, ARBS
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*** 20036APCSC---.944601626APCSCSBP(p=0.001)SBPSBPAPCSCSBP( P=0.0002)SBPSBP
4/3mmHg23CHD15HF16CV1514**:, Treat to goal 2006 (140/90 mmHg) *IIIIII ** 10mmHg10mmHg***** 10-20mmHg3 ***