高血压英文ppt精品课件managementof hypertension in older

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1、ManagementofHypertensioninOlderPersonsIntroductionBy2030,theU.S.populationofpersonswhoolderthan65yrsisexpectedtodoubletomorethan60million.65%ofAmericans60yrsandolderhaveHT.Only27%haveadequateBPcontrolProjectedpopulationoftheUnitedStates,byageandsex:20

2、00to2050.AccessedonlineSeptember29,2004,IntroductionNormotensiveat55agehave90%lifetimeriskfordevelopingHT.HTandothercardiovascularriskfactorsinolderpersonsmakehighriskformorbiditymortality.Obesity,LVH,Sedentarylifestyle,Hyperlipidemia,DMBloodPressureMe

3、asurementIsolatedelevatedSBPismoreprevalentinolderpersonsbecauseofincreasedlarge-arterystiffness.JNC7:-SBPshouldbetheprimarytargetforthediagnosisandcareofolderpersonswithHT.BloodPressureMeasurementBPshouldbebasedontheaverageof2ormoreproperlymeasuredrea

4、dings,inthesittingposition,on2ormoreofficevisits.Age-relateddecreasesinbaroreflexresponsemayleadtoorthostatichypotension,soBPshouldbemonitoredinthesittingandstandingpositions.BloodPressureMeasurementPseudohypertension-BPcufffailstocompressacalcifiedart

5、ery.Pt.withresistantHT(Pt.withinadequateBPcontroldespitetxwithappropriate3drugregimen,Esp.orthrostatichypotension)BloodPressureMeasurementResistanthypertension-white-coathypertensionambulatorybloodpressuremonitoringmaybeusefulindocumentingwhite-coathyp

6、ertensionandverifyinghypotensivesymptomsinpatientsreceivingantihypertensiveagents.BloodPressureGoalsRecommendedbyJNC7-lessthan140/90mmHg.-lessthan130/80mmHginpatientswithDMorchronickidneydisease.-associatedwithadecreaseincardiovasculardiseasecomplicati

7、ons.BloodPressureGoalsJNC7recommendstreatingolderpatientswithstage1isolatedsystolichypertension(systolicbloodpressure140to159mmHg)stage2isolatedsystolichypertension(systolicbloodpressurehigherthan160mmHg)equalBloodPressureGoalsSystolicHypertensioninthe

8、ElderlyProgram(SHEP)-nodefinitiveevidenceofanincreaseinriskfromaggressiveuseofanti-hypertensivetherapyunlessthediastolicbloodpressurewasloweredtolessthan60mmHg.EvidenceSupportingTreatmentofHypertensionIn2000,ameta-analysisofeighttrialsw