中国高血压防治指南重点内容解释课件

1、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 mmHg160 mmHg140 mmHg130 mmHg120 mmHg100806040200020406080100False-positi

2、ve error rate (%)SensitivityPater C. Current Controlled Trials in Cardiovascular Medicine. 2019,6 : 5Systolic Blood Pressure150 mmHVasan et al. N Engl J Med. 2019;345:1291-1297.High-Normal BP and CVD RiskFramingham StudyWomen1086420Time (years)02468101214P.001MenCumulative Incidence (%i

3、me (years)02468101214P.001High 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: TC5.7mmol/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IMT0.9mm或动脉粥样斑块血请肌酐轻度升高 男性 115-133mol/L或1.3-1.5mg/dl 女性 107-12

4、4mol/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; 22:51-57454035302520151050None1234Additional risk factors13.7%39.8%32.4%12.1%2.0%5221518123546176高血压常与其它心血管危险因素合并存在%Mancia G. et al., J Hypertens Microalbuminuria65432

5、10Relative risk of IHDSBP 160Normoalbuminuria2.5 (1.2-5.3)5.3 (2.2-13.0)3.3 (1.6-6.9)2.2 (1.3-3.7)1.01.5 (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; 19:1992Microalbuminuria6543210RelativHOT 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%)YesNoGen

6、der(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

7、 factor HOT：心血管危险分层与CVD事件BMJ 2019, 324:71RR：1.58 1.38 1.60 1.79 1.51Cl:1.45-1.72 1.18-1.61 1.41-1.82 1.56-2.05 1.38-1.66P:0.0001 0.0001 0.0001 0.0001 0.0001MajorcardiovasculareventsAll myocardialinfarctionAll strokeCardiovascularmortalityTotalmortalityRisk:MediumHighVery High20151050Events per 1000

8、patient yearsHOT：心血管危险分层与CVD事件BMJ 2019, 324Risk Reclassification in APROS StudyCuspidi et al., J Hypertens 2019; 20:1307-1315100806040200%InitialFinal *HighMediumLowRisk:*After ecocardiogram +carotid ultrasonography81.3%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

9、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 mmH0.51.02.0Relative Risk RR (95% CI)BP Difference(mm Hg)FavorsFirst ListedFavorsSecond ListedMajor CV eventsCV mortalityTotal 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.

10、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 CABlood Pressure Lowering Treatment Trialists Collaboration. Lancet. 2019;362:1527-1535.BP-Lowering Treatment Tri

11、alistsComparisons of Different Active Treatments0.51.02.0Relative Risk RR (95%Fatal/Non-fatal cardiac eventsFatal/Non-fatal strokeAll-cause deathMyocardial infarctionHeart failure hospitalisations0.40.60.81.01.21.4Controlled patients*(n = 10755)Non-controlled patients(n = 4490)Hazard Ratio 95% CI*SB

12、P 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 RatioWeber 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.Follo

13、w-up (Years)Survival (%)10.960.920.880.840.8135791113151719212325P=.03P.0001P=.001Treated BP not at goal 140/90 mm Hg Untreated BP 140/90 mm Hg Untreated BP 140/90 mm HgTreated BP at goal 140/90 mm HgCVD Survival in Treated Hypertensives at Goal and Not at GoalBenetos et al. J Hypertens. 20121086420

14、8090100110120130Diastolic blood pressure (mm Hg)CV eventsElderlypatients Patients With Diabetes and other CV riskFactors HypertensivesWith average risk Hypertensives With lower thanaverage riskRelationship between diastolic (in principle, similar for systolic) blood pressures and cardiovascular (CV)

15、 events (arbitray scale) in hypertensive patients with different levels of cardiovascular risk1210864208090100110120130DiastMajor 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

16、 80 mm Hg. 302520151050 80 85 90 90 85 80P=0.50 for trendP=0.005 for trendAll hypertensive patients(n=18790)Hypertensive with diabetes(n=1501)Target blood pressure groupsMajor cardiovascular events/1000 patients-yearsHOT: 糖尿病与非糖尿病患者的CV事件发生率Major cardiovascular events (p老年高血压患者血压控制目标值调整的原因老年ISH临床试验(SHEP, SYST-EURO, SYST-CHINA) SBP目标： 150 mmHg大多数降压治疗临床试验结果： SBP目标 140 mmHg 较难达到老年高血压患者血压控制目标值调整的原因老年ISH临床试验(S常用降压药物利尿剂b-阻滞剂-阻滞剂 钙拮抗剂ACE抑制剂血管紧张素II受体拮抗剂固定剂量复方降压制剂常用降压药物