高血压联盟与转化医学课件

高血压联盟与转化医学

刘力生PurposeofWHLTodeveloporpromotehealthbyeducatingandinstructinghealthcareprofessionalsandthepubliconpreventativeandcurativemeasuresforhypertension.对专业人员和群众进行

健康促进教育Topromoteandconductresearchrelatedtothepreventionandtreatmentofhypertension促进和组织防治高血压的研究项目

Topromotethedetection,controlandpreventionofhypertensioninthepopulationthroughjointeffortsofallnationalleaguesandsocieties.

联合各国的联盟与学会促进高血压防控工作Toliaisewiththenationalbodies,promotingtheexchangeofinformationamongthem,andofferinginternationallyapplicablemethodsandprogramsforhypertensioncontrol.与各国家团体联系,交流提供有关控制高血压的国际可行的方法与计划.转化医学与中国高血压联盟转化医学是本世纪从循证医学发展而形成的一个医学实践和干预性流行病学的理念，它融汇基础科学、社会科学、政治科学于一体，兼顾治病和预防，其涵盖的领域已超出现行医疗保健服务的范畴。Frombenchtobedsidetopopulation(实验室—临床—社区）

转化医学研究可分为： 1期：基础实验研究 2期：基础研究应用于临床:临床试验,中国高血压指南 3期：改变环境与政策层面的因素才能做到临床公共卫生和预防措施的可持续发展。健康促进与社区防治

HypertensionClinicalTrials

中国临床试验的经验

LiuLishengChronicDiseaseinChina

-2007CVDReportofChina

中国慢病现状Newonsetstroke:2million/yr，Survivedstroke:13millionCVDpatients:230millionNewonsetMI:

0.5million，survivedMI:3million；CHD:8milllionPatientswithchronicdiseasesin2003:574million：DM: 33million--Cancer: 46millionCerebrovasculardiseases: 93millionCardiacdisease:

165millionHypertension: 237millionTrialsYearContributionsSyst.-ChinaChineseSystolicHT

intheElderlyTrial1998Totalmortality,CVDmortality&StrokemortalityreducedbyCCBbasedtreatmentinisolatedsystolicHTptsPATsPostStrokeAntiHTTreatmentStudy1996BPreductioninpoststrokepts.Reducedstrokerecurrence,eveninnormotensiveSTONEAntihypertensive

tr.in

elderlyCCBeffectiveinstrokereductioninelderhypertensivesFEVERChineseFelodipineEventReductionTrial2004MoreorlessantihypertensivetreatmentonstrokeHypertensionClinicalTrialsinChinaTrialsYearContributionsPROGRESSThePerindoprilProtectionAgainstRecurrentStrokeStudy

2001PoststrokeantihypertensivetreatmenteffectivelyreducedtherecurrenceofstrokeinpatientssufferedfromstrokeCREATEClinicalTrialofReviparinandMetabolicModulationinAcuteMyocardialInfarctionTreatmentEvaluation2005PostMI:useofreviparinisbeneficialADVANCEActionindiabetes&VascularDisease:PreteraxandDiamicaronMrControlledEvaluaton2006Antihypertensivetr.reducetheeventsofmacro-andmicro-vasculareventsinpatientswithDM(bloodpressurearm)InternationalTrialsTrialsYearContributions&problemsWAVETheWarfarinAntiplateletVascularEvaluationStudymorehemorragicsideeffectsinChineseOASIS-6OrganizationfortheAssessmentofStrategiesforIschemicSyndromes-62006POISEEffectsofextended-releasemetoprololsuccinateinpatientsundergoingnon-cardiacsurgery2008InternationalTrialsTrialsYearContributionsONTARGET/TRANSENDOngoingTelmisartanAloneandinCombinationwithRamiprilGlobalEndpointtrial/TelmisartanRandomizedAssessmentStudyinACEIntolerantSubjectswithCVD2008RASblocadetreatmenteffectivelyreduceCVDeventswitheitherACEIorARBratherthanbothHYVETTheHypertensionintheVeryElderlyTri2008AntihypertensivetreatmentreducedmajorCVDeventsandmortalityinveryelderly(>=80yrs)hypertensivepatientsInternationalTrialsExperience(1/2)Easiertorecruitparticipantsfromclinicsor

communities.

Concommitantdrugtreatmentareless.

largesimpletrialsarefeasible

inChina.Example:Chinesesubjects

inHYVET

(40%oftotalsample)Slightlyyounger,lighter&shorter.Smokedmorebutdranklessalcohol.LesspreviousepisodesofMI,morepreviousstrokeHadlowerbloodurea,uricacidandCr,higherHDLC.Bloodglucose&TC,Na&K,bloodhaematocrit&Hbwerealllower.Mucheasiertorecruit,lessconcomitanttr.Morecomplianttotr.EasiertoFU.Experience(2/2)CHLwasestablishedontopofSyst.-China&PATsCollaborativegroup(31medicaluniversities)in1989&continuingonorganizingRCTsbothnationally&internationalyEstablishedgoodrelationshipwithworldwellknownRCTCenters,implicatingRCTresultsinChinesepopulationsuccessfully.Forex.CCBbasedtr.usedwidelyinISH,captoprilinpostMIafterSyst-ChinaandCCS1trials.Translationalmedicineisatwo-way

streetDrivetocureshouldbecomplementedbygoingbackfrombedsidetolaboratorywith

observationsmadeinhumanstudiesPharmacogenetics

&individualized

medicineWarfarin

dosage

inAsianpeopleCanfolicacidpreventstroke?ChinaStrokePrimaryPreventionTrial

Warfarinmaintenancedosesvaryamongdifferentpopulations:Asiansrequirelowerdoses

EthnicityWarfarindoseReferencesAsianChinese3.3(mg/day)Q.J.Med.89,127-135Japanese3.3(mg/day)Clin.Pharmacol.Ther.63,519-528CaucasianAmerican5.1(mg/day)JAMA,287,1690-1698.Italian5.5(mg/day)Blood,105,645-649.“CertainsinglenucleotidepolymorphismsintheVKORC1gene(especiallythe-1639G>Aallele)havebeenassociatedwithlowerdoserequirementsforwarfarin”.DescriptionofcurrentchangestotheCrestorlabelInapharmacokineticstudyinvolvingadiversepopulationof

AsiansresidingintheUnitedStates,rosuvastatindruglevels

werefoundtobe

elevatedapproximately2-fold

comparedwithaCaucasiancontrolgroup.Asaresultofthesefindings,the“DosageandAdministration”sectionofthelabelnowstatesthatthe

5mgdoseofCrestorshouldbeconsideredasthestartdoseforAsianpatients

andanyincreaseindoseshouldtakeintoconsiderationtheincreaseddrugexposureinthispatientpopulation.Resultsofthispharmacokineticstudyarefurtherdiscussedunderthe“ClinicalPharmacology”and“Precautions”sectionoflabeling.EthnicallyDifferentDoseRecommendationPharmacogenetics

&individualized

medicineWarfarin

dosageinRCT(wavestudy)Canfolicacidprevent

stroke?

ChinaStrokePrimary

PreventionTrial中国高血压指南项目设计开放性、多中心的横断面观察性登记研究，入组已接受降压药物治疗的门诊高血压患者全国22个城市，100家三甲医院涉及心血管科、肾内科、内分泌科纳入5000例高血压患者以下问题为本研究关注重点：-患者的人口学特征-患者的血压控制情况-患者的心血管危险因素及相关实验室检查结果-患者的降压药物应用情况-患者的关于高血压治疗的认知状况的调查Surveyof

hyperTensive

pAtienTs

blood

pressUre

controlrateinclinic

Service两大权威机构联合发起并主办总结三甲医院心血管科、肾内科、内分泌科门诊高血压患者血压<140/90mmHg达标率为45.1%糖尿病或肾病患者血压(<130/80mmHg)和其他患者（<140/90mmHg）血压达标率为31.1%最常见的合并疾病依次为血脂异常(43.2%)、糖尿病(37.1%)、冠心病(22.6%)及肾功能不全(18.3%)68.9%1992--1994199820022009BP未达标BP达标已接受治疗的高血压患者中血压<140/90mmHg不断提高！2006年中国心血管病报告0%20%40%60%80%100%87.3%80.1%75%54.9%12.7%19.9%25.0%87.3%80.1%75%54.9%12.7%19.9%25.0%45.1%68.9%31.1%31.1%45.1%CHINASTATUS数据引发的思考但我们仍然面临挑战31.1%的达标率对我们是否已经足够好?多数高血压患者合并其他疾病，降压需要更关注器官的保护60%的患者从不漏服降压药物，而总体达标率31.1%，(<140/90mmHg为45.1%)提示我们是否应该选择更强更有效的治疗方案，以使血压尽早达标。

我们仍要为提高我国高血压患者的知晓率，治疗率和达标率、继续努力！继续教育与宣传群众可持续发展的社区防治EpidemiologicalreportfromChinaDATAFROM5-AND10–YEARFOLLOW-UPSURVEYSOF10,450WORKERS