老年高血压患者的治疗

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1、ACCinChinaHypertension,PreventionandLipids(HPL)JiguangWANG,MD,PhDShanghaiInstituteofHypertension,RuijinHospital,Shanghai,Chinajiguangw@gmail.comManagementofhypertensionintheelderlyJiguangWANG,MD,PhDShanghaiInstituteofHypertension,RuijinHospital,Shanghai,Chinajiguangw@gmail.comSizeoftheproble

2、m:hypertensionCarefulselectionofantihypertensivedrugstopotentiatethehugebenefitandtoavoidthepotentialharmRoadmaptocontrolbloodpressureinresistanthypertensivepatientsAwareness,treatmentandcontrolratesofhypertensioninChinaPrevalenceNumberofpatientsAwarenessTreatedControlled1991(>15y)11.3％94mil

3、lion26.6％45.5%(12.1％)23.1%(2.8％)2002(18y）18.8％160million30.2％81.8%(24.7％)25.0%(6.1％)2002(60y）49.1％~70million37.6％96.3%(36.2％)24.1%(7.6％)ChinJHypertens1995;3(suppl):14-18;LiLiming,etal.ChinJEpidemiol2005;26:,478-484.Sizeoftheproblem:hypertensionCarefulselectionofantihypertensivedrugstopoten

4、tiatethehugebenefitandtoavoidthepotentialharmRoadmaptocontrolbloodpressureinresistanthypertensivepatientsRelativeriskreductionsbyantihypertensivetreatmentinearlytrialsProgressiontosevereHTCHFStrokeCHDTotalmortalityCVmortality-94％*-53%*-40%*-16%*-13%-21%**P<0.05CollinsRetal.BrMedBull1994;50:2

5、72-298.BPLTTC.Lancet2003;362:1527-45.0-5-10-15-20-25-30StrokeCHDCHFTotalmortality-23%-15%-16%-14%－4/3mmHgN＝20888MajorCVevents-15%Relativeriskreductionsbyantihypertensivetreatmentinrecenttrials指南推荐利尿剂阻滞剂钙离子拮抗剂转换酶抑制剂血管紧张素受体拮抗剂JHypertens2007;25:1105-87.INTERMAP:UrinaryelectrolytesinmenZhouBFet

6、al.JHumHypertens2003;17:623–630.JapanChinaUKUSAUrinaryNa(mg/day)4843563337024202UrinaryNa(mmol/day)211245161183UrinaryK(mg/day)1920150629122512UrinaryK(mmol/day)49.238.674.764.4UrinaryNa/K(mmol/mmol)4.56.82.33.1INTERMAP:UrinaryelectrolytesinwomenZhouBFetal.JHumHypertens2003;17:623–630.JapanC

7、hinaUKUSAUrinaryNa(mg/day)4278483929293272UrinaryNa(mmol/day)186210127142UrinaryK(mg/day)1891147523781982UrinaryK(mmol/day)48.537.961.050.8UrinaryNa/K(mmol/mmol)4.16.02.23.1HYVET:Serumconcentrationsofcholesterol,sodiumandpotassiumLiuLSetal.ChinMedJ