老年高血壓患者的治療

1、ACC in ChinaHypertension, Prevention and Lipids (HPL),Jiguang WANG, MD, PhDShanghai Institute of Hypertension, Ruijin Hospital, Shanghai, Chinajiguangw@gmail.com,Management of hypertension in the elderly,Jiguang WANG

2、, MD, PhDShanghai Institute of Hypertension, Ruijin Hospital, Shanghai, Chinajiguangw@gmail.com,,Size of the problem: hypertensionCareful selection of antihypertensive drugs to potentiate the huge benefit and to avoi

3、d the potential harmRoadmap to control blood pressure in resistant hypertensive patients,Awareness, treatment and control rates of hypertension in China,Chin J Hypertens 1995;3(suppl):14 -18; Li Liming, et al. ChinJ E

4、pidemiol 2005;26:,478-484.,,Size of the problem: hypertensionCareful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harmRoadmap to control blood pressure in resistant hype

5、rtensive patients,Relative risk reductions by antihypertensive treatment in early trials,Progression to severe HT,CHF,Stroke,CHD,Total mortality,CV mortality,-94％*,-53%*,-40%*,-16%*,-13%,-21%*,*P<0.05,Collins R et

6、al. Br Med Bull 1994;50:272-298.,BPLTTC. Lancet 2003;362:1527-45.,0-5-10-15-20-25-30,,,,,,Stroke,CHD,CHF,Total mortality,,,,,-23%,-15%,-16%,-14%,,,,－4/3 mmHg,N＝20 888,,Major CV events,-15%,Relative risk reductions

7、by antihypertensive treatment in recent trials,指南推薦,利尿劑?阻滯劑鈣離子拮抗劑轉(zhuǎn)換酶抑制劑血管緊張素受體拮抗劑,J Hypertens 2007;25:1105-87.,INTERMAP: Urinary electrolytes in men,Zhou BF et al. J Hum Hypertens 2003;17:623–630.,INTERMAP: Urinary e

8、lectrolytes in women,Zhou BF et al. J Hum Hypertens 2003;17:623–630.,HYVET: Serum concentrations of cholesterol, sodium and potassium,Liu LS et al. Chin Med J 2008; 121:1509-1512.,SHEP: New-onset diabetes mellitus,Shafi

9、T et al. Hypertension 2008;52:1022-9.,45% ? per 0.5 mmol/L ? in K+,,Size of the problem: hypertensionCareful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harmRoadmap t

10、o control blood pressure in resistant hypertensive patients,,Resistant Hypertension: Diagnosis, Evaluation, and Treatment. A Scientific Statement From the AHA Professional Education Committee of the Council for High BP R

11、esearchHypertension 2008,Pharmacologic recommendations for the treatment of resistant hypertension (1),,Use of a long-acting thiazide diuretic, preferably chlorthalidone Combine agents with different mechanisms of a

12、ction Recommended triple regimen of - ACE inhibitor or ARB - Calcium channel blocker- Thiazide diuretic,Consider addition of mineralocorticoid receptor antagonist. Use of loop diuretic may be necessary in

13、patients with CKD (creatinine clearance <30 mL/min).,Pharmacologic recommendations for the treatment of resistant hypertension (2),Number No. drugs ?2 drugsALLHAT42,4241.840%ANBP26083 2.050%ASCOT19,

14、2572.378%CONVINCE16,6021.840%INVEST22,5763.085%LIFE91932.046%VALUE15,2452.054%,,,,,,,,Number of drugs in recent large HT trials,Achieved 135/76147/82136/77136/79131/76144/81138/78,

15、Catheter-Based Renal Sympathetic Denervationfor the Management of Resistant Hypertension,Henry Krum MBBS PhD FRACPCentre of Cardiovascular Research & Education in Therapeutics, Monash University/Alfred Hospital;Al

16、fred Heart Centre, The Alfred Hospital, Melbourne, Australia,Treatments,Catheter-Based Renal Sympathetic Denervationfor the Management of Resistant Hypertension,Henry Krum MBBS PhD FRACPCentre of Cardiovascular Researc

17、h & Education in Therapeutics, Monash University/Alfred Hospital;Alfred Heart Centre, The Alfred Hospital, Melbourne, Australia,Results: Blood Pressure Reduction,87% had a reductionin SBP ≥ 10 mmHg,P<0.001 excep

18、t for DBP at 12 months (P=0.02),Conclusions,? Therapeutic renal sympathetic denervation produced predictable, significant, and sustained reductions in BP in patients with resistant hypertension.? The brief and simple pr

19、ocedure was performed without significant complications to either the renal artery or the kidney.? Results appear both to confirm the important role of renal sympathetic nerves in resistant hypertension and to suggest t

20、hat renal sympathetic denervation could be of therapeutic benefit in this patient population.? Prospective randomized clinical trials examining the treatment of hypertension are beginning in 2009, and trials in heart fa

21、ilure and chronic kidney disease are anticipated.,,因?yàn)橹獣月实?、用藥后血壓控制率低，我?0%以上的高血壓患者的血壓未得到有效控制(<140/90 mm Hg)，在廣大農(nóng)村該比例甚至高達(dá)96.5%。因此，必需大幅度提高高血壓檢出率與治療控制率。指南推薦使用的5大類降壓藥物均可在50%以上的患者中發(fā)揮降壓作用。在關(guān)注降壓達(dá)標(biāo)的同時，應(yīng)盡可能減少降壓藥物的不良反應(yīng)，降低降壓治療的代