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1、ACC in China Hypertension, Prevention and Lipids (HPL),Jiguang WANG, MD, PhD Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai, China ,Management of hypertension in the elderly,Jiguang WANG, MD, PhD Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai, China ,Size of the problem
2、: hypertension Careful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harm Roadmap 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 Lim
3、ing, et al. ChinJ E pidemiol 2005;26:,478-484.,Size of the problem: hypertension Careful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harm Roadmap to control blood pressure in resistant hypertensive patients,Relative risk reductions by antihypertensiv
4、e treatment in early trials,Progression to severe HT,CHF,Stroke,CHD,Total mortality,CV mortality,-94*,-53%*,-40%*,-16%*,-13%,-21%*,*P0.05,Collins R et 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 mmH
5、g,N20 888,Major CV events,-15%,Relative risk reductions by antihypertensive treatment in recent trials,指南推荐,利尿剂 阻滞剂 钙离子拮抗剂 转换酶抑制剂 血管紧张素受体拮抗剂,J Hypertens 2007;25:1105-87.,INTERMAP: Urinary electrolytes in men,Zhou BF et al. J Hum Hypertens 2003;17:623630.,INTERMAP: Urinary electrolytes in women,Zhou
6、BF et al. J Hum Hypertens 2003;17:623630.,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 T et al. Hypertension 2008;52:1022-9.,45% per 0.5 mmol/L in K+,Size of the problem: hypertension Careful se
7、lection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harm Roadmap to control blood pressure in resistant hypertensive patients,Resistant Hypertension: Diagnosis, Evaluation, and Treatment. A Scientific Statement From the AHA Professional Education Committee of
8、the Council for High BP Research Hypertension 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 action Recommended triple regimen of - ACE inhibitor or ARB -
9、 Calcium channel blocker - Thiazide diuretic,Consider addition of mineralocorticoid receptor antagonist. Use of loop diuretic may be necessary in patients with CKD (creatinine clearance 30 mL/min).,Pharmacologic recommendations for the treatment of resistant hypertension (2),Number No. drugs 2 drugs
10、 ALLHAT 42,424 1.8 40% ANBP2 6083 2.0 50% ASCOT 19,257 2.3 78% CONVINCE 16,602 1.8 40% INVEST 22,576 3.0 85% LIFE 9193 2.0 46% VALUE 15,245 2.0 54%,Number of drugs in recent large HT trials,Achieved 135/76 147/82 136/77 136/79 131/76 144/81 138/78,Catheter-Based Renal Sympathetic Denervation for the
11、 Management of Resistant Hypertension,Henry Krum MBBS PhD FRACP Centre of Cardiovascular Research Alfred Heart Centre, The Alfred Hospital, Melbourne, Australia,Treatments,Catheter-Based Renal Sympathetic Denervation for the Management of Resistant Hypertension,Henry Krum MBBS PhD FRACP Centre of Ca
12、rdiovascular Research Alfred Heart Centre, The Alfred Hospital, Melbourne, Australia,Results: Blood Pressure Reduction,87% had a reduction in SBP 10 mmHg,P0.001 except for DBP at 12 months (P=0.02),Conclusions, Therapeutic renal sympathetic denervation produced predictable, significant, and sustaine
13、d reductions in BP in patients with resistant hypertension. The brief and simple procedure 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
14、that 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 failure and chronic kidney disease are anticipated.,因为知晓率低、用药后血压控制率低，我国90%以上的高血压患者的血压未得到有效控制(140/90 mm Hg)，在广大农村该比例甚至高达96.5%。因此，必需大幅度提高高血压检出率与治疗控制率。 指南推荐使用的5大类降压药物均可在50%以上的患者中发挥降压作用。在关注降压达标的同时，应尽可能减少降压药物的不良反应，降低降压治疗的代价。 联合降压治疗，特别联合使用3个以上药物时，不仅可以提高降压达标的比例，很可能还可更有效地降低心脑血管并发症的风险。但即便使用多个降压药物，仍会有比例很低，但绝对数量巨大的高血压患者，可能需要寻求药物以外的治疗手段，不管是外科手术治疗，还是介入治疗方法。,Thank you very much ！,