血压变异性临床研究进展 李为民(ppt)

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1、血压变异性临床研究进展哈尔滨医科大学附属第一医院李为民2011坛论压血高东北ChineseMulti-ProvincialCohortStudy(CMCS)高血压是心脑血管疾病主要危险因素JAMA.2004Jun2;291(21):2591-9202067339934455441135134424010203040506070(%)CHD缺血性卒中出血性卒中CVD高血压吸烟高TC低HDL糖尿病肥胖降血压是硬道理！?Averageafter1styear:133.5Standardvs.119.3Intensive,Delta=14.2Me

2、an#MedsIntensive:3.23.43.53.4Standard:1.92.12.22.3ACCORDtrial：SBPreductionPrimaryOutcomeNonfatalMI,NonfatalStrokeorCVDDeathTotalMortalityHR=0.8895%CI(0.73-1.06)HR=1.0795%CI(0.85-1.35)ACCORDtrial：ClinicalOutcomes(n=2,255)ReferenceINVESTtrial:Outcomes–TightControlGroupOther

3、significantvariablesinCoxregressionmodel:age,race,PAD,MI,CHF,USresidency,renalimpairment,LVH,TIA/stroke61个前瞻性观察性研究的荟萃分析共入选100万成年人随访1270万人-年降压可有效降低心脑血管事件发生风险SBP下降2mmHg脑卒中死亡率下降10%冠心病死亡率下降7%*Epidemiologicstudies,notclinicaltrialsofhypertensionagents.LewingtonSetal.Lancet.20

4、02;360:1903-1913.第59届亚特兰大ACC震撼公布ASCOT-BPLABPVLancet杂志接连刊登相关文章全面引爆BPV热议血压变异性(BPV):21世纪高血压治疗的临床新指标59thACCScientificCongress2010-03-16，AtlantaBPVariabilityandCardiovascularOutcomesPSSever,PMRothwell,SCHoward,JEDobson,BDahlöf,HWedel,NRPoulter,fortheASCOTInvestigatorsInternat

5、ionalCentreforCirculatoryHealth,ImperialCollegeLondonandStrokePreventionResearchUnit,UniversityofOxfordSystolicanddiastolicbloodpressureBloodpressure(mmHg)6080100120140160180Follow-up(years)Baseline0.511.522.533.544.555.5amlodipineperindoprilatenololbendroflumethiazide1

6、37.7136.179.277.4Meandifference1.9LastvisitMeandifference2.7SBPDBP163.9164.194.894.5ASCOT研究显示：氨氯地平+ACEI组与阿替洛尔+利尿剂组相比平均血压差异2.7/1.9mmHg冠脉事件获益13%卒中事件获益23%=？微小的平均诊室血压差异不足以解释如此显著的心脑血管获益Whatisbeyondmeanbloodpressure?Whatonearthcausesthesebenefits?平均血压？其他危险因素？个体差异？高血压患者的24小时血压不断

7、变化180160140120100806040SD24=15.5mmHgdaySD=9.2mmHgnightSD=8.9mmHg(9.2x14)+(8.9x6)SDdn==9.1mmHg14+61214161820220246810HoursSBP(mmHg)BiloGetal.JHypertens2007;25:2058-66.(SDdxHrd)+(SDnxhrn)SDdn=hrd+hrn诊室血压不能代表整体血压状况平均血压变化-20(mmHg)药物A药物B诊所血压常规测量时间动态血压监测给药NeutelJM,BloodPressure

8、Monitoring2001,6:9-16-15-10-50时间(h)07:0011:0015:0019:0023:0003:0007:00Toolimited诊室血压的控制不代表24小时整体