高血壓合并冠心病的優(yōu)化治療課件

高血壓合并冠心病的優(yōu)化治療南京醫(yī)科大學(xué)第二附屬醫(yī)院心內(nèi)科龍明智KeyQuestionsCurrentstatusofhypertensionwithCADWhatdrugsshouldyouuse?BloodpressuregoalsAssociateandreflection高血壓是我國(guó)嚴(yán)重的么共衛(wèi)生問(wèn)題《中國(guó)心血管病報(bào)告2014》●心血管病是中國(guó)居民的首位死亡原因高血壓是導(dǎo)致心腦血管病的第1位危險(xiǎn)因素●2013年中國(guó)高血壓人數(shù)2.7億全國(guó)每年約有350萬(wàn)人死于心血管病990-2013年中國(guó)城市、農(nóng)村居民心血管病死亡率變化一城市2572629901995200020052006200720082002010201120122013《中國(guó)心血管病報(bào)告2014》Gwast,NOVARTIS中國(guó)、美國(guó)心血管流行病學(xué)趨勢(shì)比較中國(guó)人新血音死亡軍強(qiáng)勁上升美國(guó)人群心血管死亡軍顯者下降腦血管病冠心病冠心病198519902010中國(guó)慍性病報(bào)告(2006)NHLBIChartbook2007不同防治措施對(duì)美國(guó)冠心病死亡率下降的貢獻(xiàn)PCIforchronicangina(1.3%CABGforchronicangina.7%statinprimarySmoking.7preventon4.9%BP201%.Chol24\2%RiskfaTXofHT7%PhysicalA,5.1reduction44%9%DM98%10%InitialTxforAMianduA11%2ndpreventionpostAMIorPCINEnglJMed2007June7:356:2388(Includingstatins)TrendsofLeadingcausesofdeathintaiwanAge-standardized1/100000√75%Heartdisease,47.4Stroke,30.6Htpneumonia,25.0chkidneydis.12.4DOH.Tawan.2011WangTD,2011Long-TermBenefitsofBPLoweringSBPReductionsof10mmHgreducetheRiskofCvEventsbyUpto40%Meta-analysisof61prospective,observationalstudies◆1millionadu|ts.12.7millionperson-yearsStrokeMl30%reductioninheartdiseasedeath10mmHgdecreaseusual"SBPdirectestimation40%reductioninAdjustmentforriskofstrokedeathregressiondilutionbias(usualBPhypothesIsWangTD,sheuWHHHypertensRes2011,34:49-51LewingtonS,etal.Lancet2002,360-1903-1913降壓可減少心腦血管事件發(fā)生(BPLTTO數(shù)據(jù))血壓降低8/4mmHg時(shí),心腦血管事件降低比例腦卒中CHDcV死亡cV事件全因死亡18%22%N=16234138%高血壓和冠心病協(xié)同發(fā)病率高冠狀動(dòng)脈粥樣硬化患者60%-70%