高血壓聯(lián)盟與轉化醫(yī)學課件

高血壓聯(lián)盟與轉化醫(yī)學

劉力生PurposeofWHLTodeveloporpromotehealthbyeducatingandinstructinghealthcareprofessionalsandthepubliconpreventativeandcurativemeasuresforhypertension.對專業(yè)人員和群眾進行

健康促進教育Topromoteandconductresearchrelatedtothepreventionandtreatmentofhypertension促進和組織防治高血壓的研究項目

Topromotethedetection,controlandpreventionofhypertensioninthepopulationthroughjointeffortsofallnationalleaguesandsocieties.

聯(lián)合各國的聯(lián)盟與學會促進高血壓防控工作Toliaisewiththenationalbodies,promotingtheexchangeofinformationamongthem,andofferinginternationallyapplicablemethodsandprogramsforhypertensioncontrol.與各國家團體聯(lián)系,交流提供有關控制高血壓的國際可行的方法與計劃.轉化醫(yī)學與中國高血壓聯(lián)盟轉化醫(yī)學是本世紀從循證醫(yī)學發(fā)展而形成的一個醫(yī)學實踐和干預性流行病學的理念，它融匯基礎科學、社會科學、政治科學于一體，兼顧治病和預防，其涵蓋的領域已超出現(xiàn)行醫(yī)療保健服務的范疇。Frombenchtobedsidetopopulation(實驗室—臨床—社區(qū)）

轉化醫(yī)學研究可分為： 1期：基礎實驗研究 2期：基礎研究應用于臨床:臨床試驗,中國高血壓指南 3期：改變環(huán)境與政策層面的因素才能做到臨床公共衛(wèi)生和預防措施的可持續(xù)發(fā)展。健康促進與社區(qū)防治

HypertensionClinicalTrials

中國臨床試驗的經(jīng)驗

LiuLishengChronicDiseaseinChina

-2007CVDReportofChina

中國慢病現(xiàn)狀Newonsetstroke:2million/yr，Survivedstroke:13millionCVDpatients:230millionNewonsetMI:

0.5million，survivedMI:3million；CHD:8milllionPatientswithchronicdiseasesin2003:574million：DM: 33million--Cancer: 46millionCerebrovasculardiseases: 93millionCardiacdisease:

165millionHypertension: 237millionTrialsYearContributionsSyst.-ChinaChineseSystolicHT

intheElderlyTrial1998Totalmortality,CVDmortality&StrokemortalityreducedbyCCBbasedtreatmentinisolatedsystolicHTptsPATsPostStrokeAntiHTTreatmentStudy1996BPreductioninpoststrokepts.Reducedstrokerecurrence,eveninnormotensiveSTONEAntihypertensive

tr.in

elderlyCCBeffectiveinstrokereductioninelderhypertensivesFEVERChineseFelodipineEventReductionTrial2004MoreorlessantihypertensivetreatmentonstrokeHypertensionClinicalTrialsinChinaTrialsYearContributionsPROGRESSThePerindoprilProtectionAgainstRecurrentStrokeStudy

2001PoststrokeantihypertensivetreatmenteffectivelyreducedtherecurrenceofstrokeinpatientssufferedfromstrokeCREATEClinicalTrialofReviparinandMetabolicModulationinAcuteMyocardialInfarctionTreatmentEvaluation2005PostMI:useofreviparinisbeneficialADVANCEActionindiabetes&VascularDisease:PreteraxandDiamicaronMrControlledEvaluaton2006Antihypertensivetr.reducetheeventsofmacro-andmicro-vasculareventsinpatientswithDM(bloodpressurearm)InternationalTrialsTrialsYearContributions&problemsWAVETheWarfarinAntiplateletVascularEvaluationStudymorehemorragicsideeffectsinChineseOASIS-6OrganizationfortheAssessmentofStrategiesforIschemicSyndromes-62006POISEEffectsofextended-releasemetoprololsuccinateinpatientsundergoingnon-cardiacsurgery2008InternationalTrialsTrialsYearContributionsONTARGET/TRANSENDOngoingTelmisartanAloneandinCombinationwithRamiprilGlobalEndpointtrial/TelmisartanRandomizedAssessmentStudyinACEIntolerantSubjectswithCVD2008RASblocadetreatmenteffectivelyreduceCVDeventswitheitherACEIorARBratherthanbothHYVETTheHypertensionintheVeryElderlyTri2008AntihypertensivetreatmentreducedmajorCVDeventsandmortalityinveryelderly(>=80yrs)hypertensivepatientsInternationalTrialsExperience(1/2)Easiertorecruitparticipantsfromclinicsor

communities.

Concommitantdrugtreatmentareless.

largesimpletrialsarefeasible

inChina.Example:Chinesesubjects

inHYVET

(40%oftotalsample)Slightlyyounger,lighter&shorter.Smokedmorebutdranklessalcohol.LesspreviousepisodesofMI,morepreviousstrokeHadlowerbloodurea,uricacidandCr,higherHDLC.Bloodglucose&TC,Na&K,bloodhaematocrit&Hbwerealllower.Mucheasiertorecruit,lessconcomitanttr.Morecomplianttotr.EasiertoFU.Experience(2/2)CHLwasestablishedontopofSyst.-China&PATsCollaborativegroup(31medicaluniversities)in1989&continuingonorganizingRCTsbothnationally&internationalyEstablishedgoodrelationshipwithworldwellknownRCTCenters,implicatingRCTresultsinChinesepopulationsuccessfully.Forex.CCBbasedtr.usedwidelyinISH,captoprilinpostMIafterSyst-ChinaandCCS1trials.Translationalmedicineisatwo-way

streetDrivetocureshouldbecomplementedbygoingbackfrombedsidetolaboratorywith

observationsmadeinhumanstudiesPharmacogenetics

&individualized

medicineWarfarin

dosage

inAsianpeopleCanfolicacidpreventstroke?ChinaStrokePrimaryPreventionTrial

Warfarinmaintenancedosesvaryamongdifferentpopulations:Asiansrequirelowerdoses

EthnicityWarfarindoseReferencesAsianChinese3.3(mg/day)Q.J.Med.89,127-135Japanese3.3(mg/day)Clin.Pharmacol.Ther.63,519-528CaucasianAmerican5.1(mg/day)JAMA,287,1690-1698.Italian5.5(mg/day)Blood,105,645-649.“CertainsinglenucleotidepolymorphismsintheVKORC1gene(especiallythe-1639G>Aallele)havebeenassociatedwithlowerdoserequirementsforwarfarin”.DescriptionofcurrentchangestotheCrestorlabelInapharmacokineticstudyinvolvingadiversepopulationof

AsiansresidingintheUnitedStates,rosuvastatindruglevels

werefoundtobe

elevatedapproximately2-fold

comparedwithaCaucasiancontrolgroup.Asaresultofthesefindings,the“DosageandAdministration”sectionofthelabelnowstatesthatthe

5mgdoseofCrestorshouldbeconsideredasthestartdoseforAsianpatients

andanyincreaseindoseshouldtakeintoconsiderationtheincreaseddrugexposureinthispatientpopulation.Resultsofthispharmacokineticstudyarefurtherdiscussedunderthe“ClinicalPharmacology”and“Precautions”sectionoflabeling.EthnicallyDifferentDoseRecommendationPharmacogenetics

&individualized

medicineWarfarin

dosageinRCT(wavestudy)Canfolicacidprevent

stroke?

ChinaStrokePrimary

PreventionTrial中國高血壓指南項目設計開放性、多中心的橫斷面觀察性登記研究，入組已接受降壓藥物治療的門診高血壓患者全國22個城市，100家三甲醫(yī)院涉及心血管科、腎內科、內分泌科納入5000例高血壓患者以下問題為本研究關注重點：-患者的人口學特征-患者的血壓控制情況-患者的心血管危險因素及相關實驗室檢查結果-患者的降壓藥物應用情況-患者的關于高血壓治療的認知狀況的調查Surveyof

hyperTensive

pAtienTs

blood

pressUre

controlrateinclinic

Service兩大權威機構聯(lián)合發(fā)起并主辦總結三甲醫(yī)院心血管科、腎內科、內分泌科門診高血壓患者血壓<140/90mmHg達標率為45.1%糖尿病或腎病患者血壓(<130/80mmHg)和其他患者（<140/90mmHg）血壓達標率為31.1%最常見的合并疾病依次為血脂異常(43.2%)、糖尿病(37.1%)、冠心病(22.6%)及腎功能不全(18.3%)68.9%1992--1994199820022009BP未達標BP達標已接受治療的高血壓患者中血壓<140/90mmHg不斷提高！2006年中國心血管病報告0%20%40%60%80%100%87.3%80.1%75%54.9%12.7%19.9%25.0%87.3%80.1%75%54.9%12.7%19.9%25.0%45.1%68.9%31.1%31.1%45.1%CHINASTATUS數(shù)據(jù)引發(fā)的思考但我們仍然面臨挑戰(zhàn)31.1%的達標率對我們是否已經(jīng)足夠好?多數(shù)高血壓患者合并其他疾病，降壓需要更關注器官的保護60%的患者從不漏服降壓藥物，而總體達標率31.1%，(<140/90mmHg為45.1%)提示我們是否應該選擇更強更有效的治療方案，以使血壓盡早達標。

我們仍要為提高我國高血壓患者的知曉率，治療率和達標率、繼續(xù)努力！繼續(xù)教育與宣傳群眾可持續(xù)發(fā)展的社區(qū)防治EpidemiologicalreportfromChinaDATAFROM5-AND10–YEARFOLLOW-UPSURVEYSOF10,450WORKERS