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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,中国高血压防治指南重点内容解释课件,中国高血压防治指南重点内容解释课件,血压水平的分类和定义,分类 收缩压(mmHg)舒张压(mmHg),正常血压 120 和 80,正常高值 120-139 或 80-89,高血压,140 或,90,1级 140-159 或 90-99,2级 160-179 或 100-109,3级,180 或,110,单纯收缩期高血压,140 和,90,血压水平的分类和定义 分类 收缩压(,Systolic Blood Pressure,150 mmHg,160 mmHg,140 mmHg,130 mmHg,120 mmHg,100,80,60,40,20,0,0,20,40,60,80,100,False-positive error rate(%),Sensitivity,Pater C.Current Controlled Trials in Cardiovascular Medicine.2019,6:5,Systolic Blood Pressure150 mmH,Vasan et al.,N Engl J Med.,2019;345:1291-1297.,High-Normal BP and CVD Risk,Framingham Study,Women,10,8,6,4,2,0,Time(years),0,2,4,6,8,10,12,14,P,.001,Men,Cumulative Incidence(%),14,12,10,8,6,4,2,0,Time(years),0,2,4,6,8,10,12,14,P,.001,High normal 130-139/85-89 mm Hg,Normal 120-129/80-84 mm Hg,Optimal 55岁,女性65岁,吸烟,血脂异常:TC,5.7mmol/L(220mg/dl),或LDL-C3.3mmol/L(130mg/dl),或HDL-C1.0mmol/L(40mg/dl),早发心血管病家族史(一级亲属发病年龄,38mv,Cornel2440mmmms,超声心动图LVMI或X线,颈动脉超声IMT,0.9mm或动脉粥样斑块,血请肌酐轻度升高,男性,115-133,mol/L或1.3-1.5mg/dl,女性,107-124,mol/L或1.2-1.4mg/dl,微量白蛋白尿,30-300mg/24h,白蛋白/肌酐:男性,22mg/g(2.5mg/,mmol),女性,31mg/g(3.5mg/,mmol),靶器官损害左心室肥厚,Mancia G.et al.,J Hypertens 2019;22:51-57,45,40,35,30,25,20,15,10,5,0,None,1,2,3,4,Additional risk factors,13.7%,39.8%,32.4%,12.1%,2.0%,522,1518,1235,461,76,高血压常与其它心血管危险因素合并存在,%,Mancia G.et al.,J Hypertens,Microalbuminuria,6,5,4,3,2,1,0,Relative risk of IHD,SBP 160,Normoalbuminuria,2.5(1.2-5.3),5.3(2.2-13.0),3.3(1.6-6.9),2.2(1.3-3.7),1.0,1.5(0.9-2.7),收缩压、微量蛋白尿与心血管危险,Borch-Johnsen K,et al.Arteioscler Thromb Vasc Biol 2019;19:1992,Microalbuminuria6543210Relativ,HOT,心血管危险因素研究,血压水平以外的各项因素对,CVD,发生率的影响,Risk factor CV/1000 pt.yRRCl(95%),YesNo,Gender(M vs F)12.07.21.62(1.421.94),Age(65 vs 65 yrs)15.07.32.06(1.772.39),Smoking 14.08.91.57(1.311.88),S-Cholesterol(6.8 vs,6.8 mmol/l)11.69.01.29(1.091.53),S-Creatinine(1.3 vs,1.3 mg/dl)21.88.72.50(2.033.07),Diabetes 18.39.02.03(1.652.51),Ischemic Heart Disease 18.48.12.27(1.932.68),HOT 心血管危险因素研究Risk factor,HOT：心血管危险分层与CVD事件,BMJ 2019,324:71,RR：1.58 1.38 1.60 1.79 1.51,Cl:1.45-1.72 1.18-1.61 1.41-1.82 1.56-2.05 1.38-1.66,P:0.0001 0.0001 0.0001 0.0001 0.0001,Major,cardiovascular,events,All myocardial,infarction,All stroke,Cardiovascular,mortality,Total,mortality,Risk:,Medium,High,Very High,20,15,10,5,0,Events per 1000 patient years,HOT：心血管危险分层与CVD事件BMJ 2019,324,Risk Reclassification in APROS Study,Cuspidi et al.,J Hypertens 2019;20:1307-1315,100,80,60,40,20,0,%,Initial,Final*,High,Medium,Low,Risk:,*After ecocardiogram+,carotid ultrasonography,81.3%,18.7%,53.2%,35.7%,11.1%,Risk Reclassification in APROS,血压控制目标值,中青年高血压患者 140/90 mmHg,老年,高血压,患者,150/90 mmHg,糖尿病或肾病患者130/,80,mmHg,血压控制目标值中青年高血压患者 140/90 mmH,0.5,1.0,2.0,Relative Risk,RR(95%CI),BP Difference(mm Hg),FavorsFirst Listed,Favors,Second Listed,Major CV events,CV mortality,Total mortality,1.02(0.98,1.07),2/0,ACEI vs D/BB,1.03(0.95,1.11),2/0,ACEI vs D/BB,1.00(0.95,1.05),2/0,ACEI vs D/BB,1.04(0.99,1.08),1/0,CA vs D/BB,1.05(0.97,1.13),1/0,CA vs D/BB,0.99(0.95,1.04),1/0,CA vs D/BB,0.97(0.92,1.03),1/1,ACEI vs CA,1.03(0.94,1.13),1/1,ACEI vs CA,1.04(0.98,1.10),1/1,ACEI vs CA,Blood Pressure Lowering Treatment Trialists Collaboration.,Lancet,.2019;362:1527-1535.,BP-Lowering Treatment Trialists,Comparisons of Different Active Treatments,0.51.02.0Relative Risk RR(95%,Fatal/Non-fatal cardiac events,Fatal/Non-fatal stroke,All-cause death,Myocardial infarction,Heart failure hospitalisations,0.4,0.6,0.8,1.0,1.2,1.4,Controlled patients*,(n=10755),Non-controlled patients,(n=4490),Hazard Ratio 95%CI,*SBP 140 mmHg at 6 months.,Pooled,Treatment,Groups,*,*,*,*,*,P,0.01.,0.75(0.670.83),0.55(0.460.64),0.79(0.710.88),0.86(0.731.01),0.64(0.550.74),Odds Ratio,Weber MA et al.,Lancet.,2019;363:204749.,VALUE:根据6个月时血压控制情况的结果分析,Fatal/Non-fatal cardiac events,中国高血压防治指南重点内容解释课件,Benetos et al.,J Hypertens,.2019;21:1635-1640.,Follow-up(Years),Survival(%),1,0.96,0.92,0.88,0.84,0.8,1,3,5,7,9,11,13,15,17,19,21,23,25,P,=.03,P,.0001,P,=.001,Treated BP not at goal 140/90 mm Hg,Untreated BP 140/90 mm Hg,Untreated BP,140/90 mm Hg,Treated BP at goal 140/90 mm Hg,CVD Survival in Treated Hypertensives at Goal and Not at Goal,Benetos et al.J Hypertens.20,12,10,8,6,4,2,0,80,90,100,110,120,130,Diastolic blood pressure(mm Hg),CV events,Elderly,patients,Patients,With,Diabetes,and other,CV risk,Factors,Hypertensives,With average risk,Hypertensives,With lower than,average risk,Relationship between diastolic(in principle,similar for systolic)blood pressures,and cardiovascular(CV)events(arbitray scale)in hypertensive patients with different levels of cardiovascular risk,1210864208090100110120130Diast,Major cardiovascular events(per 100 patients-years)in all treated hypertensive,and in hypertensive patients with diabetes in relation to target blood pressures,of 90.85,and 80 mm Hg.,30,25,20,15,10,5,0,80,85,90,90,85,80,P=0.50 for trend,P=0.005 for trend,All hypertensive patients,(n=18790),Hypertens
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