中国高血压防治指南培训手册.ppt
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1、Hypertension高血压,Definition,Hypertension is defined as a SBP of 140 mmHg or greater and/or a DBP of 90 mmHg or greater in subjects who are not taking antihypertensive medication.95%Essential or primary hypertension 5%Secondary hypertension,Epidemiology,Prevalence rate(患病率)of hypertension in China:In
2、1959-5.11%In 1979-7.73%In 1991-11.88%In 2004-18.80%The prevalence of high BP increases with age.Hypertension is more common in men than in women up to age 50,after that age,hypertension is more common in women.Hypertension is more common in northern China than in southern China.,Etiology and pathoge
3、nesis of EH,No cause can be establishedPossible factors Genetic tendency Spontaneous hypertension rat EH tends to cluster in families Environemnts,高血压,遗 传,环 境,高 盐 饮 食,肥胖,精神压力过重,饮 酒,体育锻炼少,Pathogenesis of EH,sympathetic nervous system activity RAAS肾脏潴钠Vessel remoldingVascular endothelium dysfunction n
4、itric oxide endothelin Insulin resistance(胰岛素抵抗)sodium reabsorption,sympathetic nervous system activity,intracellular Na Ca,病 理,血管:全身细小动脉病变大中动脉病变 心:左心室后负荷增加心肌肥厚 与扩大心力衰竭;动脉粥样硬化脑:脑小动脉硬化。脑血栓、脑出血、脑水肿肾:肾细小动脉硬化。肾单位萎缩 肾功能衰竭,Clinical findings,BP波动-,White coat EHSymptoms-Mild to moderate EH is usually associ
5、ated with normal health for many years.Some patients have headache,tinnitus(耳鸣),palpitation,tiredness(疲劳),and so on.Signs-BP is elevated.Some patients have a loud aortic second sound and an early systolic ejection click(收缩期喷射喀喇音).,Clinical findings(Continue),Complications:Hypertensive cardiovascular
6、 disease,CHD Hypertensive cerebrovascular disease Hypertension is the major predisposing cause of stroke.Hypertensive renal disease Chronic hypertension leads to nephrosclerosis(肾硬化症)Aortic dissection(主动脉夹层),blood pressure measurement,WHO不同测量方法的高血压定义 SBP DBP 诊室偶测血压 140 90 在家测量血压 135 8524小时动态测压 130 8
7、0,Normal reference of ABPM(mmHg),24h Daytime Nighttime SBP DBP SBP DBP SBP DBPStaessen 133 82 140 88 125 76JNC-7 135 85 120 75China3 130 80 135 85 125 75,Laboratory investigations,Routine investigationsUrinalysis(尿液检查)Serum potassium,BUN(尿素氮),Cr(肌苷),Serum uric acid(尿酸),Fasting glucose,Plasma cholest
8、erol,and so on.,Laboratory investigations,ECGUCG ventricular hypertrophyChest X-ray ventricular enlargementFunduscopic examination retina arteriolar narrowing arteriovenous nicking(动静脉交叉压迫)hemorrhage,exudate(渗出)papilledema(视神经乳头水肿),Diagnosis&differential diagnosis,To confirm a chronic elevation of b
9、lood pressure and determine its levelTo identify secondary causes of hypertension To determine the presence of target-organ damage and to quantify its extentTo search for other cardiovascular risk factors&clinical conditions that may influence prognosis&treatment,Classification of Blood Pressure Lev
10、els(mmHg),Category Systolic DiastolicOptimal 120 80Normal 130 85High-normal 130-139 85-89Grade 1 hypertension(mild)140-159 90-99 Subgroup:borderline 140-149 90-94Grade 2 hypertension(moderate)160-179 100-109Grade 3 hypertension(severe)180 110 Isolated systolic hypertension 140 90 Subgroup:borderline
11、 140-149 90,2003 美国JNC-7 血压水平分类,中国2004高血压指南,类 别 收缩压(mmHg)舒张压(mmHg)正常血压 120 80 正常高值 120139 8089 高血压 140 901级高血压(轻度)140159 90992级高血压(中度)160179 100109 3级高血压(重度)180 110单纯收缩期高血压 140 90,Stratification of Risk to Quantify Prognosis,危险分层 The prognosis(预后)of patients with hypertension should not be based on
12、the level of BP alone,but also on the presence of other risk factors,target organ damage as well as concomitant diseases such as diabetes,&cardiovascular or renal disease.,Risk factors used for risk stratification,Levels of SBP and DBP(grades 1-3)Men55 yearsWomen65 yearsSmokingTC5.72mmol/L DiabetesF
13、amily history of premature cardiovascular disease(早发心血管病家族史)(Men55 years,Women65 years),Target-organ damage,Left ventricular hypertrophy(ECG、echocardiography or chest X-ray)Proteinuria(蛋白尿)and/or slight elevation of plasma creatinine(肌酐)concentration(106-177mol/L)Ultrasound or radiological evidence
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