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最新高血压指南的几个问题 .ppt
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    最新高血压指南的几个问题

    刘力生

    内容提要

    ? 关于血压水平的定义和分类

    ? 关于危险度分层

    ? 关于卫生经济学

    ? 关于用药问题

    高血压患者危险分层--WHO/ISH 1999

    影响高血压患者预后的因素

    高血压患者危险分层--2003欧洲高血压指南

    血压分类--JNC-VI(1997)

    ---------------------------------------------------------

    类 别 收缩压(mm Hg) 舒张压(mm Hg)---------------------------------------------------------

    理想血压 <120 <80

    正常血压 120 - 129 80 - 84

    正常高值 130 - 139 85 - 89

    1级高血压 140 - 159 90 - 99

    亚组:临界高血压 140 - 149 90 - 94

    2级高血压 160 - 179 100 -109

    3级高血压 ?180 ?110

    单纯收缩期高血压 ?140 <90

    亚组:临界收缩期高血压 140 - 149 <90

    ---------------------------------------------------------------

    1. Distribution of NHANES I Epldemiologic Follow-up Study Participants with a High-Normal BP or Hypertension at

    Baseline According to BP Lovel and Risk Categorization

    2. Estimated Effect of a 12mmHg Reduction in SBP Over 10 years on the Number-Needed-to-Treat to Prevent a Cardiovascular Disease Event Among NHANES I Epidemiologic Follow-Up Study Participants According to Baseline BP Level and Category of Presumed Cardiovascular Risk

    3. Estimated Effect of a 12mmHg Reduction in SBP Over 10 years on the Number-Needed-to-Treat to Prevent a Cardiovascular Disease Death Among NHANES I Epidemiologic Follow-Up Study Participants According to Baseline BP Level and Category of Presumed Cardiovascular Risk

    4. Estlmated Effect of a 12mmHg Reduction in SBP Over 10 years on the Number-Needed-to-Treat to Prevent An AI-Cause Death Among NHANES I Epidemiologic Follow-Up Study Participants According to Baseline BP Level and Category of Presumed Cardiovascular Risk

    不同危险程度高血压患者的血压水平(mmHg, x?s)

    男 女

    危险度 SBP DBP SBP DBP

    低危 141.3(12.0)88.7(7.9)141.7(10.8)88.4(10.1)

    中危 144.7(15.6)89.3(9.7)144.1(26.7)86.4(10.6)

    高危 144.0(17.7)88.8(11.5)139.6(18.6)85.6(14.5)

    极高危 148.4(21.5)*88.8(12.8)145.9(22.6)*87.6(34.2)

    * P<0.05

    心血管危险度分层的重要性(一)

    ? 高血压常常伴随其它危险因素

    ? 降压治疗的目的是减少心血管发病与死亡(CVD Risk),而不仅是降低血压(RFs) ......

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