老年高血压患者的治疗-PPT课件

(mg/day)
(mmol/day) (mg/day) (mmol/day)
4278
186 1891 48.5
Urinary Na/K
(mmol/mmol)
4.1
6.0
2.2
3.1
Zhou BF et al. J Hum Hypertens 2019;17:623–630.
HYVET: Serum concentrations of cholesterol, sodium and potassium
INTERMAP: Urinary electrolytes in women
Japan Urinary Na
Urinary Na Urinary K Urinary K
China 4839
210 1475 37.9
UK 2929
127 2378 61.0
USA 3272
142 1982 50.8
26.6％
45.5% (12.1％)
23.1% (2.8％)
2019 (18 y）
18.8％
160 million
30.2％
81.8% (24.7％)
25.0% (6.1％)
2019 (60 y）
49.1％
~70 million
37.6％
96.3% (36.2％)

24.1% (7.6％)
Chin J Hypertens 2019;3(suppl):14 -18; Li Liming, et al. ChinJ E pidemiol 2019;26:,478-484.

Relative risk reductions by antihypertensive treatment in early trials
Progression CHF to severe HT
0% -10% -20% -30% -40% -50% -60% -70% -80% -90% -100%
Stroke
0
CHD
CHF
Major CV events
Total mortality
-5
-10 -15 -20 -25 -30 -23% -15% -16% -15% -14%
－4/3 mmHg
N＝20 888
BPLTTC. Lancet 2019;362:1527-45.
指南推荐
利尿剂
阻滞剂
with CKD (creatinine clearance <30 mL/min).
Number of drugs in recent large HT trials
Number ALLHAT ANBP2 ASCOT 42,424 6083 19,257 No. drugs 1.8 2.0 2.3
45% per 0.5 mmol/L in K+
Shafi T et al. Hypertension 2019;52:1022-9.

Size of the problem: hypertension Careful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harm Roadmap to control blood pressure in resistant hypertensive patients
钙离子拮抗剂 转换酶抑制剂 血管紧张素受体拮抗剂
J Hypertens 2019;25:1105-87.
INTERMAP: Urinary electrolytes in men
Japan Urinary Na Urinary Na Urinary K (mg/day) (mmol/day) (mg/day) 4843 211 1920

Resistant Hypertension: Diagnosis, Evaluation, and Treatment. A Scientific Statement From the AHA Professional Education Committee of the Council for High BP Research
Size of the problem: hypertension Careful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harm Roadmap to control blood pressure in resistant hypertensive patients
Hypertension 2019
Pharmacologic recommendations for the treatment of resistant hypertension (1)
• Use of a long-acting thiazide diuretic, preferably chlorthalidone • Combine agents with different mechanisms of action • Recommended triple regimen of - ACE inhibitor or ARB - Calcium channel blocker - Thiazide diuretic

Size of the problem: hypertension Careful selection of antihypertensive drugs to potentiate the huge benefit and to avoid the potential harm Roadmap to control blood pressure in resistant hypertensive patients
2 drugs Achieved 40% 50% 78% 135/76 147/82 136/77
CONVINCE
INVEST LIFE VALUE
16,602
22,576 9193 15,245
1.8
3.0 2.0 2.0
40%
85% 46% 54%
136/79
131/76 144/81 138/78

Awareness, treatment and control rates of hypertension in China
Prevalence Number of patients Awareness Treated Controlled
1991 (>15 y)
11.3％
94 million
China 5633 245 1506
UK 3702 161 2912
USA 4202 183 2512
Urinary K
Urinary Na/K
(mmol/day)
(mmol/mmol)
49.2
4.5
38.6
6.8
74.7
2.3
64.4
3.1
Zhou BF et al. J Hum Hypertens 2019;17:623–630.
Treatments
Catheter-Based Renal Sympathetic Denervation for the Management of Resistant Hypertension
Henry Krum MBBS PhD FRACP Centre of Cardiovascular Research & Education in Therapeutics, Monash University/Alfred Hospital; Alfred Heart Centre, The Alfred Hospital, Melbourne, Australia
Men Characteristic (mmol/L)
Total cholesterol
Women Other countries
5.45±1.1
China
4.69±1.0
China
5.02±1.1
Other countries
5.60±1.1
HDL cholesterol Sodium Potassium
ACC in China
Hypertension, Prevention and Lipids
(HPL)
Jiguang WANG, MD, PhD Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai, China jiguangwgmail
Results: Blood Pressure Reduction
P<0.001 except for DBP at 12 months (P=0.02)
87% had a reduction in SBP ≥ 10 mmHg
Conclusions
• Therapeutic renal sympathetic denervation produced predictable, significant, and sustained reductions in BP in patients with resistant hypertension. • The brief and simple procedure was performed without significant complications to either the renal artery or the kidney. • Results appear both to confirm the important role of renal sympathetic nerves in resistant hypertension and to suggest that renal sympathetic denervation could be of therapeutic benefit in this patient population. • Prospective randomized clinical trials examining the treatment of hypertension are beginning in 2009, and trials in heart failure and chronic kidney disease are anticipated.
1.37±0.36
140±4.1 4.25±0.47
1.29±0.39
142±4.1 4.42±0.40
1.43±0.36
140±4.1 4.26±0.49
1.33±0.43
142±4.3 4.38±0.40
Liu LS et al. Chin Med J 2019; 121:1509-1512.
SHEP: New-onset diabetes mellitus
Catheter-Based Renal Sympathetic Denervation for the Management of Resistant Hypertension
Henry Krum MBBS PhD FRACP Centre of Cardiovascular Research & Education in Therapeutics, Monash University/Alfred Hospital; Alfred Heart Centre, The Alfred Hospital, Melbourne, Australia
-94％* -53%*
Stroke
CHD
CV Total mortality mortality
-16%*
-13%
-21%*
-40%*
*P<0.05
Collins R et al. Br Med Bull 1994;50:272-298.
Relative risk reductions by antihypertensive treatment in recent trials
Management of hypertension in the elderly
Jiguang WANG, MD, PhD Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai, China jiguangwgmail

Pharmacologic recommendations for the treatment of resistant hypertension (2)
Consider addition of mineralocorticoid receptor
antagonist.
Use of loop diuretic may be necessary in patients