从高血压到心力衰竭挑战与对策-课件，幻灯.ppt

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1、从高血压到心力衰竭挑战与对策1.McKeeetal.NEnglJMed.1971;285:1441-1446.2.LevyD.JAMA1996;275:1557-1562.高血压:心力衰竭的主要危险因素FraminghamHeartStudyFramingham随访研究的资料显示，高血压是心力衰竭发生的主要危险因素。约90%的心力衰竭患者，在发生心力衰竭前曾有高血压史。<140/90140-159/90-99>160/100BP(mmHg)Lloyd-Jonesetal.Circulation2002;106:

2、3068-3072.3343menand4199womenfollowedfor25years–noHFatbaseline血压水平与心力衰竭危险AgeMaleFemaleMaleFemaleMaleFemale051015202530Lifetimerisk(%)40years80years60yearsYearsNormalLVSubclinicalClinicalheartLVstructureremodelingLVdysfunctionfailure&functionHeartfailureObesi

3、tyDiabetesHTNSmokingDyslipidemiaDiabetesMILVHDiastolicdysfunctionYears/monthsSystolicdysfunctionDeathVasanRSetal.ArchInternMed.1996;156:1789-1796.HTN=HypertensionMI=MyocardialInfarctionLVH=Leftventriclehypertrophy高血压如何进展到心力衰竭因心力衰竭首次住院患者左心室射血分数ALLHATHFBYEFLEV

4、ELN=1399EF<40%EF40-49%EF>50%心力衰竭预后：人群研究随访(年)死亡率(%)HF-REFHF-PEFOlmsted(1998)5.06565Framingham(1999)6.27546Helsinki(1997)4.05443心力衰竭预后：临床研究荟萃分析(Somaratne,2008)17项研究，24501例，平均治疗随访47个月38%患者死亡，RF-REF40%，HF-PEF32%降压治疗有效降低心、脑血管病事件17项临床试验荟萃分析-50-40-30-20-100Heartfai

5、lure1Fatal/Nonfatalstroke1Fatal/NonfatalCHD1Riskreduction(%)1.MoserandHerbert.JAmCollCardiol.1996;2.CollinsRetal.Lancet1990.Vasculardeaths-52%-38%-16%-21%HYVET:HeartFailureplaceboactive------Placebo____ActiveStrokeSystolicBPDifferenceBetweenRandomizedGroups(

6、mmHg)0.250.500.751.001.251.50-10-8-6-4-2024SystolicBPDifferenceBetweenRandomizedGroups(mmHg)0.250.500.751.001.251.50-10-8-6-4-2024CHDA=CAvsplacebo;B=ACEinhibitorvsplacebo;C=moreintensivevslessintensiveblood-pressure-lowering;D=ARBvscontrol;E=ACEinihibitorvsC

7、A;F=CAvsdiureticorβ-blocker;G=ACEinhibitorvsdiureticandβ-blocker.BloodPressureLoweringTreatmentTrialists’Collaboration.Lancet.2003;362:1527-1535.RRofOutcomeEventRRofOutcomeEventABCDEFGABCDEFGBP-LoweringTreatmentTrialistsHeartFailureSystolicBPDifferenceBetwee

8、nRandomizedGroups(mmHg)RRofOutcomeEvent-10-8-6-4-20240.250.500.751.001.251.50ABCDEFGA=CAvsplacebo;B=ACEinhibitorvsplacebo;C=moreintensivevslessintensiveblood-pressure-lowering;D=ARBvscontrol;E=A