改善血压控制质量和内涵.pptVIP

改善血压控制的质量和内涵 降低和控制清晨高血压 张维忠 ◆ 以长期高质量血压控制和预防或逆转靶器官损害为目标的优化治疗，更有利于指导降压治疗，并获得更大程度的益处。 ◆ 优化治疗策略需要优选降压治疗的基本元素、剂量以及联合治疗方案与路径，2009年ESH治疗指南再评价提出 Preferred drugs，Preferred combinations。 降压治疗策略的新理念 Clinic BP can represent the whole blood pressure status ? -20 -15 -10 -5 0 Time(h) 0700 1100 1500 1900 2300 0300 0700 Drug A （highT/P ratio） Drug B （low T/P ratio） Clinic BP Routine time of measurement ABPM Drug delivery Neutel JM, Blood Pressure Monitoring 2001, 6: 9-16 Average BP change(mmHg) Dolan, E. et al. Hypertension 2005;46:156–61 Superior predictive value of ABP on CV mortality The Finn-Home Study The Finn-Home Study .Hypertension 2012, 59:212-218 Prognostic Value of the Variability in Home-Measured Blood Pressure and Heart Rate 24-h Blood Pressure Profile Time of day Blood pressure (mm Hg) 18:00 22:00 02:00 06:00 10:00 14:00 18:00 Time of awakening Sleep 180 160 140 120 100 80 Millar-Craig et al, 1978; Mancia et al, 1983 清晨高血压 Morning Hypertension 清晨高血压: 清晨时段血压升高 (135/85 mmHg) 清晨高血压是隐蔽性高血压(Masked Hypertension) 的一种主要表现 清晨高血压与血压晨峰或血压昼夜节律异常 有密切关系 Cohen, MC, et al. Am J Cardiol 1997;79:1512-1516 Elliolt WJ Stroke 1998;29:992-996 CV Event is Highest In the Morning *Relative risk (95% Cl) based on proportion of actual number of incidence versus expected number of incidence (if no circadian variations existed) 50 40 30 20 10 0 Acute Ml Stroke Increase in relative risk (%)* 38% 49% ?Br J Cardiol 2008;15:31-34 High incident of Stroke MI 清晨血压与心血管风险密切相关 Kario K, et al. Diabetes Care 2002;25:2218-2223. Morning hypertension and complications in Patients with type 2 diabetes 70 60 50 40 30 20 10 0 Morning normotensives (n=73) Morning hypertensives (n=97) p0.01 Prevalence of complications (%) Neuropathy Retinopathy Coronary Artery disease Cerebrovascular disease Hypertension status and diabetes on silent cerebral infarct Eguchi K,et al. Stroke 2003;34:2471-2474. Prevalence (%) 100 80 60 40 20 0 Wh