高血压英文ppt精品课件_3

What Is Hypertension? Blood Pressure (mm Hg) Category Systolic Diastolic 140/90 mmHg. Age 4 drug therapy Young age of onset of HTN (teens, 20s) Sudden increase in BP Episodes of extreme BPs Low potassium 163:525-541 If BP 1 gm/24 h is 1 g/24 h* Goal BP: 130/80 mm Hg Not at BP goal? Intensify lifestyle changes AND Patient with elevated BP The majority of patients will require combination therapy to achieve target BP. Effective combinations are: beta blocker/diuretic ACE inhibitor/diuretic ACE inhibitor/CCB ARB/diuretic When Monotherapy is Not Enough Douglas JG et al. (ISHIB HAAWG) Arch Intern Med. 2003;163:525-541. Chobanian AV et al. (JNC 7) JAMA. 2003;289:25602572 JNC 7: If BP exceeds goal by 20/10 mmHg begin combination therapy ISHIB Consensus Statement: If BP exceeds goal by 15/10 mmHg begin combination therapy RF = risk factor. Kannel WB. Am J Hypertens. 2000;13:3S-10S. 26% 25% 22% 8% 19% Men 3 RFs 4 RFs 2 RFs No Additional RFs 5 RFs Women 27% 24% 20% 12% 17% 3 RFs 4 RFs 2 RFs No Additional RFs 5 RFs Framingham offspring (ages 18 to 74 years) with hypertension are likely to have additional risk factors Risk-Factor Clustering in Patients with Hypertension Elevated SBP Increases CHD Risk, Amplified by Hypercholesterolemia MRFIT = Multiple Risk Factor Intervention Trial. Neaton JD, et al. Arch Intern Med. 1992;152:56-64. Age-Adjusted CHD Death Rates Per 10,000 Person-Years Cholesterol Quintile, mg/dL SBP Quintile, mm Hg 33.7 21 17.1 12.7 12.2 22.6 12.3 8.3 9.6 5.9 17.7 10.9 8.5 6.3 5.5 16.7 7.9 7.9 6 4.3 13.7 5 5.6 3.4 3.1 142 132141 125131 118124 118 182 182202 203220 221244 245 n = 202,620 Results from MRFIT Most Patients Diagnosed with Hypertension and Dyslipidemia Were Not at Both Goals In a managed care population, the vast majority of patients diagnosed with hypertension and dyslipidemia (n = 154,235) were not at both goals As the number of CV risk factors increased, the rate of goal attainment decreased Adapted from Pettitt D, et al. Poster presented at: 26th annual meeting of the Society of General Internal Medicine; 2003; Vancouver, Canada. More than 90% were not at both goals Fewer than 10% were at both goals Knowing is Not the Same as Doing Oliveria et al, Arch Inter