其他危险因素和病史血压.ppt

血压控制目标值： 原则上将血压降到患者能最大耐受的水平，主张血压控制目标值至少140/90mmHg 合并糖尿病或慢性肾脏病者血压控制目标值130/80mmHg 老年收缩期性高血压的降压目标水平，收缩压140～150mmHg，舒张压90mmHg但不低于65～70mmHg 顽固性高血压治疗 定义：使用了3种以上合适剂量降压药物联合治疗，血压仍未能达到目标血压 常见原因： 血压测量错误 降压治疗方案不合理（如无利尿剂） 药物干预降压作用 容量超负荷 胰岛素抵抗 继发性高血压 高血压病理 (小结） 心脏：左心室肥厚和扩大；冠状动脉粥样硬化和微血管病变 脑：脑血管缺血和变性，易形成微动脉瘤，发生脑出血；脑动脉粥样硬化，发生脑血栓形成；脑小动脉闭塞性病变，引起腔隙性脑梗塞 肾脏：肾小球纤维化、萎缩，以及肾动脉硬化 视网膜：视网膜小动脉痉挛、硬化 * Often, benign or “malignant” hypertension is described as two different types of changes in arterioles, usually renal. Benign: Hyalization of arteriole wall Malignant: Fibrinoid necrosis and “onion skinning” of arteriole wall * Does it look like you’ve seen this somewhere before, i.e., the discussion of atherosclerosis? * * Can you understand why all of these findings can be related to LEFT sided heart failure? Ans: YES, primarily PULMONARY. * Can you understand why all of these findings can be related to RIGHT sided heart failure? Ans: YES, primarily STSTEMIC. * * * As the alveoli EXPAND in COPD, the arterioles NARROW! In which type of cor pulmonale, might there be NO RVH, acute (such as massive PE or “saddle” embolism”), or chronic? * A reasonably logical way of looking at COR PULMONALE, or RIGHT HEART FAILURE * * * * * Hypertension Pathology Department, Zhejiang University School of Medicine, Zhu keqing 竺可青， zhukeqing@, 2013-3-11 Five categories of disease account for nearly all cardiac mortality:  Congenital heart disease Ischemic heart disease Hypertensive heart disease (systemic and pulmonary) Valvular heart disease Nonischemic (primary) myocardial disease Definition Hypertension 140mmHg/90mmHg Primary/Essential hypertension 5-10% Secondary/ Symptomatic hypertension (3大原因：肾性/血管性/内分泌性） PREVALENCE: WHAT % of USA people have hypertension? PREVALENCE: WHAT % of USA people have hypertension? Answer: 25% Blood pressure regulation by the renin-angiotensin system and the central roles of sodium metabolism in sp