高血压患者抗血小板治疗.ppt

支持下述重要信息 阿司匹林通过TXA2途径起到抗血小板聚集的作用 背景资料： 当患者有（吸烟、高血压、血脂异常、糖尿病、肥胖、代谢综合症）等危险因素时，造成血管内皮功能受损，血小板活化聚集形成动脉粥样硬化。 动脉粥样硬化是一个持续的过程，主要影响大中动脉，可能从童年开始一直持续一生。 急性冠脉综合征（ACS）是动脉粥样硬化的经典范例 。 稳定的动脉粥样斑块侵入动脉腔内引起慢性缺血，根据影响的血管不同可引起稳定性心绞痛或间歇性跛行。不稳定的动脉粥样斑块可能脱落，形成富含血小板的血栓，部分或全部阻塞动脉，引起急性缺血症状。 因此动脉粥样硬化可引起不稳定性心绞痛、心肌梗死、心血管死亡、缺血性卒中/TIA和周围动脉缺血性疾病。 Reference: 1. Drouet L. Cerebrovasc Dis 2002; 13(suppl 1): 1–6. The many pathophysiologic effects of angiotensin II, mediated by stimulation of the AT1 and AT2 receptors, have diverse consequences. It is reasonable to suggest that most of these pathophysiologic effects of angiotensin II (through the stimulation of AT1 receptors) will result in pivotal, and potentially deleterious effects throughout the cardiovascular continuum. 高血压人群是心血管疾病高危人群，从流行病学角度服用阿司匹林获益高于一般人群 Abstract—To evaluate the risk of cardiovascular disease (CVD) mortality in hypertensive men according to the presence of associated risk factors (ARFs). The population was composed of 29 640 normotensive men without ARFs (reference group) and 60 343 hypertensive men (with and without ARFs) who had a standard health checkup at the Centre d’Investigations Préventives et Cliniques between 1978 and 1988. Mortality data for a mean period of 14 years were analyzed. The following ARFs were considered: total cholesterol $2.5 g/L, personal history of diabetes, smoking (current smokers), body mass index .28 kg/m2, and heart rate .80 bpm. CVD risk related to the presence of isolated hypertension (assessed in hypertensive subjects without ARFs versus the reference group) increased linearly from 15% at the age of 30 years to 134% at the age of 80 years. In hypertensive subjects, one additional ARF increased CVD risk by 56% (47% to 65%, P,0.01) in younger subjects but only by 4% (28% to 17%, P5NS) in older subjects. The role of hypercholesterolemia and tobacco smoking in CVD mortality was significantly higher in hypertensive subjects aged ,55 years than in hypertensive subjects aged $55 years (P,0.01),