高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明課件

1、Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明u腦卒中（54%）缺血性心臟?。?7%） u我國高血壓患病率：男性20%，女性17%； Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明AwarenessTreatmentControl0102030menwomenPrevalence (%)22%25%16%20% 4%5% 01020304050607080AwarenessTreatmentControlNHANES II1

2、976 1980NHANES III(phase 2)1991 1994NHANES1999 2004NHANES III(phase 1)1988 199151%31%10%73%55%29%68%54%27%72%61%35%Prevalence (%)Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明MenSystolic pressureDiastolic pressure150140130120110100908070018-2930-3940-4950-5960-6970-7980Age(year)Blood pressure(mmHg)Wom

3、enSystolic pressureDiastolic pressure15014013012011010090807018-2930-3940-4950-5960-6970-79800HispanicNon-Hispanic whiteNon-Hispanic blackAge(year)Blood pressure(mmHg)N Engl J Med 2007;357:789-96.Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明4040-4950-5960-6970-7980020406080100Isolated systolic hypert

4、ensionSystolic-diastolic hypertensionIsolated diastolic hypertensionAge(year)Frequency(%)N Engl J Med 2007;357:789-96.Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明10011012013014015030 Systolic Blood Pressure (mmHg)Body Mass Index(Kg/m2)Circulation 2008;118:2679-2686.Cardiovascular Disease高血壓合并動脈硬化的研究

5、現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Endothelial Cell:Endothelial dysfunctionIncreased permeabilityIntima:collagen, Macrophage, Leukocytes, I-CAM, MMP,TGF-, VSMCElastinMedia:VSMC, collagen, MMPsElastinAdventita:Collagen fibroblastsExtrinsi

6、c Influences: NaCl, lipids, angiotensin, sympathetic Neurohormones, shear stress, increased luminal diameterCardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Mechanical Strain-induced: Elastin Fragmentation Collagen Deposition Medial calcificationAcceleratorsAor

7、tic stiffeningIncreased pulse wave velocityHypertension IGT/DiabetesRenal Disease SmokingVascular Cell SenescenceAortic Dilatation Wall HypertrophyEndothelial Dysfunction: Reactive species Oxidized LDL Angiotensin IIAdvanced Glycation (AGEs):Impaired glucose toleranceModification of collagen Cardiov

8、ascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明 t LCommoncarotidarteryCommonfemoralarteryCardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明C

9、ardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Peak systolic pressureEnd diastolic pressureTime: period of the heart cycleinflectionpoint:arrivalof the reflected waveTrAPCardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明youngmiddleoldoldmiddleyoungRADIALAORTAJ Am Coll Cardiol 2007;50:113Cardiovascular Disease

10、高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明J Am Coll Cardiol 2007;50:113YOUNG016080100120140time(s)mmHgYOUNG016080100120140time(s)mmHgOLD016080100120140mmHgOLD016080100120140mmHgRADIALAORTACardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明

11、Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明 Eur Heart J.2006.27:2588-2605.Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明N Engl J Med 2007;357:789-96.Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明2007 Guidelines for the management of arterial hypertension. Eur Heart J. 2007;28:1462-1536 Cardiovascular D

12、isease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明； 。（Ann Intern Med.2002.136:438-448）Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明0123457090110130150170190Active-treatment groupPlacebo group0Systolic blood pressureDiastolic blood pressureNo. at riskPlacebo group1912 1468 701 33

13、0 191 116Active-treatment group1933 1540 754 373 207 118YearsBlood Pressure(mm Hg)N Engl J Med.2008.358:1887-1898.Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明012340.01.02.03.04.05.06.07.08.0P=0.06Placebo groupActive-treatmentgroupFatal or Nonfatal StrokeNo. at riskPlacebo group 1912 1484 807 374 194

14、Active-treatment group 1933 1557 873 417 229Follow-up (yr)No.of Events per 100 patientsN Engl J Med.2008.358:1887-1898.Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明012340102030Placebo group Active- treatment groupP=0.02Death From Any Cause Follow-up(yr)No. of Events per 100 patientsN Engl J Med.2008.

15、358:1887-1898.0123402468Follow-up (yr)P0.001Placebo group Active-treatment groupHeart FaliueNo. of Events per 100 patientsCardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明Am J Physiol Renal Physiol.2009.297:F237-243.Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明0

16、204060800500100015002000Age(years)PWV(cm/second)J Am Coll Cardiol 2007;50:113Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明全球食鹽攝入量地區(qū)分布Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明l Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明低鈉代用鹽的降壓研究中國代用鹽研究Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明低鈉代用鹽的降壓研究復(fù)合離子鹽%9

17、965%/30%0.50.1%/0.8%0.50.1mg/Kg/4mg/Kg0.50.1mg/Kg1.00.3mg/Kg205025mg/Kg/12Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明低鈉代用鹽的降壓研究復(fù)合離子鹽Am J Hypertens 2009; 22:934-942 Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明第三部分 低鈉復(fù)合離子鹽研究Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明第三部分 低鈉復(fù)合離子鹽研究Cardiovascular Dise

18、ase高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明低鈉代用鹽的降壓研究復(fù)合離子鹽*baselinemonth 2month 4month 601060708090100Normal SaltCompound Ion Salt74.976.474.173.777.773.276.371.6Time after RandomizationPulse Pressure (mmHg)Am J Hypertens 2009; 22:934-942 Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明低鈉代用鹽的降壓研究復(fù)合離子鹽Cardiovascular Disease高血壓合并動脈硬化的研究現(xiàn)狀治療及展望李玉明低鈉代用鹽的降壓研究復(fù)合離子鹽Cardi