高血压的分级、分期、分型管理-血管与心、脑、肾等器官结

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1、高血压的分级、分期、分型管理-血管与心、脑、肾等器官结构与功能检测-上海交通大学医学院附属瑞金医院上海市高血压研究所王继光jiguangw@gmail.com0306090120150198519901995200020052010(year)StrokeCHDStandardizedrate(1/100,000)DeathsattributedtostrokeandCHD《ChinaCVDreport2005》100120140160180200无血管或靶器官损害有血管或靶器官损害血管或靶器官并发症分级(stageorgrade)高血压分级、分期、分型的

2、基本理念708090100110120舒张压，mmHg收缩压，mmHg分型(phenotypingorpathophysiology)分期(stratificationorseverity)继发性高血压有可测量异常的高血压动脉硬化性高血压高血压分级--准确测量血压，使用普遍有效的降压药物高血压分期--测量血管与靶器官的结构与功能，选择强适应症药物高血压分型--筛查病因以及影响血压的主要因素，采取病因治疗措施坐位袖带血压计24-hambulatoryBPmonitoring1501401301201101009080706050812161014182024

3、422268HourofthedayBP(mmHg)135120857024-hmeanDaytimemeanNight-timemeanWhitecoathypertensionMaskedhypertensionJingNing:Prevalenceofwhite-coat,masked,andsustainedhypertension806040200Prevalence(%)Normotension46.4%(n=322)7.8%(n=54)10.8%(n=75)35.0%(n=243)White-coatHTMaskedHTSustainedHT

4、WangGL,etal.JHypertens2007;25:2398–2405.n=694NICE2011:DefinitionsStage1hypertension:ClinicBPis140/90 mmHgorhigherandABPMorHBPMaverageis135/85 mmHgorhigher.Stage2hypertension:ClinicBPis160/100 mmHgorhigherandABPMorHBPMdaytimeaverageis150/95 mmHgorhigher.Severehypertension:Clinicsys

5、tolicBPis180 mmHgorhigherorClinicdiastolicBPis110 mmHgorhigher.KrauseT,etal.BMJ2011;343:d4891.A：ACEIorARB；B：β-blockers；C：DihydropyridineCCBs；D：Thiazides；α：α-blockers；F：FixeddosecombinationDefinitivehypertensionMonotherapyCombinationBP<160/100mmHg；orlowriskpatientsBP≥160/100mmHg；or

6、highriskpatientswithaBP>20/10mmHgfromthegoalCADBC+AA+DC+DC+BFStep1FC+AA+DC+BC+DC+D+AC+A+BA+D+αStep2C+A+DC+A+BA+D+αOtherantihypertensivedrugs,suchasclonidipine,etc.Step3Chinesehypertensionguidelines:ChoiceofantihypertensivedrugsChinJCardiol2011;39:579-616.Step4NICE2011:Summaryofant

7、ihypertensivedrugtreatmentAged55yorblackpersonofAfricanorCaribbeanfamilyoriginofanyageAgedunder55yearsCAA+CA+C+DResistanthypertensionA+C+D+considerfurtherdiureticoralpha-orbeta-blocker5ConsiderseekingexpertadviceStep1Step2Step3KeyA–ACEinhibitororlow-costangiotensin IIreceptorblo

8、cker(ARB)1C–Calcium-channelblocke