canadian recommendations for the management of hypertension ...课件

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1、CanadianRecommendationsfortheManagementofHypertensionPreparedbyLianneTileMDFRCPCSeptember2003Hypertension:PartIIPharmacologicalManagementReferencesFeldmanRD,CampbellNRC,LarochellePetal.1999Canadianrecommendationsforthemanagementofhypertension.CMAJ1999;161(supp12):1-17.FeldmanRetal.TheC

2、anadianHypertensionEducationProgramRecommendations:what’snew,what’soldbutstillimportantin2003.JournalofHypertension2003.August,P.InitialTreatmentofHypertension.NEJM2003;348;7610-17.OutlineAttheendofthisseminiaryouwillbefamiliarwith:IndicationsfordrugtreatmentWhichdrugsshouldbeprescribeda

3、sfirst-linetherapy?Subsequenttherapy?GoalsoftreatmentIndividualizationoftherapyLevelsofEvidenceA-therecommendationwasbasedon1ormorestudiesatlevelI(RCTorequivalentwithasignificantresult)B-thebestevidenceavailableisatlevelII(RCTthatdoesnotmeetlevelIcriteria)C-thebestevidenceavailableisatle

4、velIII(nonrandomizedtrial)D-thebestevidenceavailablewaslowerthanlevelIII(i.e.caseseries)andincludedexpertopinionCaseMrs.X,our54-yearold,moderatelyobesebutotherwisehealthypatient,isseeninfollowup.Remember:Bothherfatherandhermotherarehypertensive.Herfatherhadastrokeattheageof64.Thereisnota

5、rgetorgandamage,andlipids,glucose,andEKGarenormal.Herbloodpressureisnow>155/95over5visitsandathome,despitelifestylechanges.What(ifany)antihypertensivemedicationwouldyoustart?WhatisthetargetBP?LifestyleModificationsTheycanwork!Inselectedpatients,thesecanlowerBPsimilartoasingleantihyperten

6、sivemedicationInterventionTargetedchangeSBP/DBPSodiumreduction100mmol/day-5.8/-2.5Weightloss-4.5kg-7.2/-5.9Alcoholreduction<2.7drinks/day-4.6/-2.3Exercise3times/week-10.3/-7.5DietaryDASHdiet-11.4/-5.5Indicationsfordrugtreatment:adults<60y.o.sustaineddiastolicbloodpressureof90mmHgorhigher

7、,especiallywithcardiovasculardiseaseorriskfactors,ortarget-organdamage(gradeA)diastolicBPof100mmHgorhigherevenwhennoothercardiovascularriskfactorsarepresent(gradeA)medicationshouldbeconsideredinisolatedsystolichypertension(systolicBP>160mmHg),particularlyinthosewithtarget