高血压抗动脉粥样硬化治疗策略_黄峻演示文稿.ppt

高血压抗动脉粥样硬化治疗策略;高血压从 “无需治疗”时代穿越; 罗斯福总统最后一个任期时的文件詳細记载了他的健康 Franklin D. Roosevelt （FDR） was referred to Dr.?Howard Bruenn, a cardiologist at Bethesda Naval Hospital who, on March 27, 1944 found him cyanotic, breathless, with an enlarged left ventricle and a blood pressure of 186/108. Bruenn diagnosed hypertensive heart disease and wanted to give digitalis, but was prohibited by Dr.?Ross McIntire, the presidents personal physician and then surgeon-general of the U.S. Navy. The next day, FDR developed moist rales at the base of the right lung. During a press conference that day, FDR was asked about his physical condition and answered, I got bronchitis. By March 30 crackles were present at the base of both lungs. Bruenn diagnosed congestive heart failure, but it was not until the next day, after FDR was examined by civilian consultants, that digitalis was begun. FDR would continue the digitalis for the rest of his life. By April 3, FDR was better. His color was better, he could lie flat without dyspnea, and the crackles disappeared from both lungs. His blood pressure, however, was 210/110. The nation was stunned when FDR died unexpectedly on April 12, 1945 -- less than six months after being elected to a fourth term in office. The death was unexpected because the presidents personal physician, VADM Ross McIntire, whenever asked, had proclaimed that FDRs health was excellent. 1944年3月27日：血压186/108 1944年4月3日：血压210/110 总统的医生宣称：罗斯福总统健康状况很好！ 1945年4月12日，罗斯福总统死於脑溢血。 ;高血压治疗发展史（20世纪初中期）;百年高血压治疗史：成绩斐然;脑卒中;-60;治疗的高血压患者;高血压患者的冠心病风险;Libby P. Circulation. 2001;104:365-372; Ross R. N Engl J Med. 1999;340:115-126.;荟萃分析：降压＋抗AS能实现更多心血管保护;降压＋他汀进一步显著获益ASCOT给了充分的回答;Sever PS, et al, Lancet. 2003;361:1149-58;Sever PS, et al, Lancet. 2003;361:1149-58;ASCOT研究之后：各种指南迅速作出反应;ASCOT研究推动了欧洲高血压指南的更新;高血压的治疗目标;未来之路……;回归临床，对高血压抗AS治疗策略付诸实践的几点思考;（1）When;朝鲜战争阵亡美国士兵的尸检报告：动脉粥样硬化已经普遍存在;Collaboration group.Chinese J Pathology 1983, 12(2):81;阵线前移：从“亡羊补牢”推进到“未雨稠繆”;(2)Whom;;高血压患者中危险因素越多，心血管病风险越高;冠心病等危症 有