高血压英文PPT精品课件心血管疾病的流行病学
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高血压英文PPT精品课件心血管代谢风险
total cholesterol = 210 ▪ Weight = 230 lbs; BMI = 29 kg/m² ▪ Family history of HTN and diabetes
▪ Age ▪ Race/ethnicity ▪ Gender ▪ Family history
47 African American Male HTN and diabetes
and potential risk for future disease and complications
▪ Is inclusive of all risks related to metabolic changes
associated with CVD
▪ Accommodates emerging risk factors as useful
Centers for Disease Control & Prevention, Division for Heart Disease and Stroke Prevention, "Addressing the Nation's Leading Killers: At A Glance 2007
predictive tools
▪ Focuses clinical attention to the value of systematic
evaluation, education, disease prevention and treatment
▪ Supports an integrated approach to care
Kahn, et al. The Metabolic Syndrome: Time for a Critical Appraisal: Joint Statement From the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care. 2005;28 (9)2289-2304.
▪ Age ▪ Race/ethnicity ▪ Gender ▪ Family history
47 African American Male HTN and diabetes
and potential risk for future disease and complications
▪ Is inclusive of all risks related to metabolic changes
associated with CVD
▪ Accommodates emerging risk factors as useful
Centers for Disease Control & Prevention, Division for Heart Disease and Stroke Prevention, "Addressing the Nation's Leading Killers: At A Glance 2007
predictive tools
▪ Focuses clinical attention to the value of systematic
evaluation, education, disease prevention and treatment
▪ Supports an integrated approach to care
Kahn, et al. The Metabolic Syndrome: Time for a Critical Appraisal: Joint Statement From the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care. 2005;28 (9)2289-2304.
高血压英文PPT精品课件HeartMuscleDisease
Diagnosis of Dilated Cardiomyopathy
Exclude other causes of contractile failure (HTN, CAD, valvular disease).
Test for specific etiologies ?Percutaneous endomyocardial biopsy
Extremities: Mild edema of both feet and ankles.
Dilated Cardiomyopathy
Dilation of one or both ventricles Globally impaired ventricular systolic
function: both ventricles or predominantly the left ventricle. Isolated RV cardiomyopathy is rare.
medications.
Physical Exam
BP 105/70, P 98 regular, T 98.6, RR 20 Carotids are low volume with normal upstroke. JVP elevated: 10 cm above the sternal angle. Lungs: Bibasilar rales. Heart: PMI diffuse, palpable at the anterior axillary line.
Dynamic murmur of HOCM
• Smaller LV volume brings septum closer to anterior MV leaflet: more obstruction and louder murmur.
【高血压英文PPT精品课件】 cardiovascular disease (CVD)
Adhesion Molecules
Monocyte
Vessel Lumen LDL
Endothelium
LDL
ห้องสมุดไป่ตู้
Cytokines
Oxidized LDL
Macrophage
Intima
Macrophages take up modified LDL
Monocyte
Adhesion Molecules
Different from arteriosclerosis (hardening of the arteries), which is due to calcification of the arterial wall.
Oxidized LDL Induces leukocyte “homing”
Etiology
• Mutations in the gene coding for LDL receptors
Protein synthesis, expost and import
Ways to get proteins into organelles or membranes
Co-translational import
Genetic factors are prevalent (like in familial hypercholesterolemia)
Familial Hypercholesterolemia
Incidence: 1 in 500 The most common known form of genetic disease Results in
Atherosclerosis: A disease of large and mediumsized arteries that results in progressive accumulation of smooth muscle cells and lipids within the intima. Typically kills by inducing myocardial infarction
高血压英文PPT精品课件Cerebrovascular
deficit that has a sudden onset, lasts more than 24 hours, and results from cerebrovascular disease.
A stroke occurs when there is a disruption
of blood flow to a region of the brain.
Dysphasia: difficulty in speaking and putting words into the correTATIONS
A stroke is usually characterized by the sudden onset of focal neurological impairment.
About one-fourth of strokes are hemorrhagic, resulting from hypertensive vascular disease (which causes an intracerebral hemorrhage), a ruptured aneurysm, or an arteriovenous malformation.
Risk factors for stroke include smoking, hypertension, obesity, cardiac disease, hypercholesterolemia, diabetes, and use of birth control pills.
Prevention efforts focus on lifestyle changes that can modify risk factors.
PATHOPHYSIOLOGY
A stroke occurs when there is a disruption
of blood flow to a region of the brain.
Dysphasia: difficulty in speaking and putting words into the correTATIONS
A stroke is usually characterized by the sudden onset of focal neurological impairment.
About one-fourth of strokes are hemorrhagic, resulting from hypertensive vascular disease (which causes an intracerebral hemorrhage), a ruptured aneurysm, or an arteriovenous malformation.
Risk factors for stroke include smoking, hypertension, obesity, cardiac disease, hypercholesterolemia, diabetes, and use of birth control pills.
Prevention efforts focus on lifestyle changes that can modify risk factors.
PATHOPHYSIOLOGY
高血压(英文版) ppt课件
arteriole structure Compliance of Vessel wall
ppt课件 6
Psychological factors Renin –angiotensin aldosterone system（RAAS） Sodium and hypertension Abnormality of vascular endothelium（ET，NO， AngII, PGI2, etc) Insulin resistance revascularization other（obesity，smoking，drinking，hypocalcium, hypomagnesium, hypopotassium）
Heart failure Systolic hypertension 长效） Diabetes, proteinuria Renal insufficiency(mild) Myocardial infarction ACEI Stable angina Disorder of lipid pregnancy Prostate proliferation
ppt课件
12
Risk factor of cardiovascular disease
male > 55, female> 65 smoking Total cholesterol> 5.72mmol/L (250mg/dl) diabetes Early cardiovascular family history（early onset of CV disease male<55；female <65)
Diuretics ß–blocker a-blocker Calcium channel blocker ACE inhibitor Angiotensin II receptor blocker compound anti-hypertensive agents
高血压英文PPT精品课件HYPERTENSIONANDVASCULAR
Moderation of alcohol consumption
Hale Waihona Puke Limit consumption to no more than 2 drinks (1 oz or 30 mL ethanol; eg, 24 2–4 mm Hg oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter-weight persons.
(elevated serum creatinine,
▪(2) Renovascular disease
abnormal urinalysis),
(abdominal bruits)
▪(3) APKD-autosomal dominant
polycystic kidney disease (abdominal or flank masses)
Prehypertension:
recheck in 1 year
2. Stage 1 hypertension: SBP 140–159 or DBP 90–99
Stage 1 hypertension:
confirm within 2 months
2 separate office visits)
▪(5) Primary hyperaldosteronism
(hypokalemia)
7
JNC VII 2003 recommendations
Normal: recheck in 2 years (see Comments)
高血压(英文版) ppt课件
Etiology and pathogenesis of EH
No
cause can be established Possible mechanisms Genetic tendency
Spontaneous hypertension rat EH tends to cluster in families
Classification of Blood Pressure Levels (mmHg)
Category Systolic Diastolic Hypotension??? <60 Optimal <120 <80 Normal <130 <85 High-normal 139 85-89 Grade 1 hypertension(mild) 90-99 Subgroup: borderline 90-94
Optional investigations
Plasma renin( 肾 素 ) activity & aldosterone (醛固酮), urinary VMA（香草杏仁酸），to identify secondary hypertension Echocardiography, to detect ventricular hypertrophy Vascular ultrasonography should be performed if arterial disease is suspected. Renal ultrasonography should be performed if renal disease is suspected.
perhaps by catecholamines儿茶酚胺
【高血压精品英文课件】高血压 Hypertension
Pathophysiology
Hypertensive Emergency
Failure of normal autoregulatory function Leads to a sharp increase in systemic
vascular resistance Endovascular injury with arteriole necrosis Ischemia, platelet deposition and release of
Epidemiology
Why should we care about hypertension?
One of the most common chronic medical concerns in the US
Affects >30% of the population > age 20 Risk factor for
vasoactive substances Further loss of autoregulatory mechanism Exposes organs to increased pressure
Diagnosis and Recognition
Presentation
Always present with a new onset symptom
Take a good history
History of HTN and previous control Medications with dosage and compliance Illicit drug use, OTC drugs
Diagnosis and Recognition
Normal BP
【高血压英文PPT精品课件】 心血管疾病的流行病学
- Study of the natural history of CVD - Formulation and testing of etiological
hypotheses (risk factors) - Contribution to the development of
cardiovascular prevention programs and the measurement of their effectiveness
EPIDEMIOLOGY OF CARDIOVASCULAR DISEASE
(CVD)
Public Health BETTINA PIKO, M.D., Ph.D.
Types of Cardiovascular Disease
- Coronary heart disease (CHD, ischemic heart disease, heart attack, myocardial infarction, angina pectoris)
- Cerebrovascular disease (stroke, TIA, transient ischemic attack)
- Hypertensive heart disease - Peripheral vascular disease - Heart failure
- Rheumatic heart disease (streptococcal infection)
Parts of Cardiovascular Epidemiology
1., Descriptive epidemiology:
= Describing distribution of cardiovascular disease by means of certain characteristics such as : PERSON (i.e., age, gender, ethnicity) TIME and PLACE
hypotheses (risk factors) - Contribution to the development of
cardiovascular prevention programs and the measurement of their effectiveness
EPIDEMIOLOGY OF CARDIOVASCULAR DISEASE
(CVD)
Public Health BETTINA PIKO, M.D., Ph.D.
Types of Cardiovascular Disease
- Coronary heart disease (CHD, ischemic heart disease, heart attack, myocardial infarction, angina pectoris)
- Cerebrovascular disease (stroke, TIA, transient ischemic attack)
- Hypertensive heart disease - Peripheral vascular disease - Heart failure
- Rheumatic heart disease (streptococcal infection)
Parts of Cardiovascular Epidemiology
1., Descriptive epidemiology:
= Describing distribution of cardiovascular disease by means of certain characteristics such as : PERSON (i.e., age, gender, ethnicity) TIME and PLACE
【医学英文精品课件】心血管疾病流行病学 EPIDEMIOLOGY OF CARDIOVASCULAR DISEASE (CVD)
CVD made up 16.7 million of global deaths in 2002, among which 7 million due to coronary heart disease, 6 million due to stroke
Distribution of types of CVD in global deaths : Global cardiovascular deaths in 2002: 16.7 million among which: coronary heart disease 7.2 million
2., Analytic epidemiology
= Analyzing relationships between CVD and risk factors (which elevate the probability of a disease at population level), risk model and multicausal developments
Descriptive Epidemiology II. AGE
Question: What is the relative amount of CVD in death rates in different age groups?
- Early lesions of blood vessel, atherosclerotic plaques: around 20 years - adult lifestyle patterns usually start in childhood and youth (smoking, dietary habits, sporting behavior, etc.)
Distribution of types of CVD in global deaths : Global cardiovascular deaths in 2002: 16.7 million among which: coronary heart disease 7.2 million
2., Analytic epidemiology
= Analyzing relationships between CVD and risk factors (which elevate the probability of a disease at population level), risk model and multicausal developments
Descriptive Epidemiology II. AGE
Question: What is the relative amount of CVD in death rates in different age groups?
- Early lesions of blood vessel, atherosclerotic plaques: around 20 years - adult lifestyle patterns usually start in childhood and youth (smoking, dietary habits, sporting behavior, etc.)
高血压英文PPT精品课件Diseasesofthe
• CAD • Almost all from atherosclerotic narrowing
or complete obstruction • Depending on the degree & character of
the obstruction
– angina pectoris – MI – sudden cardiac death – chronic ischemic heart disease with CHF
Diseases of the Heart
Major Determinants of Disease
• Most heart disease is the result of atherosclerotic obstruction of the coronary arteries
• Congestive heart failure is mechanical failure of the heart to eject blood delivered to it
• Premature ventricular contractions
– occur in healthy people – chest palpitations & anxiety
• Ventricular tachycardia
– spontaneous, regular beating at > 120 beats/min
• Each year heart disease accounts for about 1/3 of deaths in the US, most of which are associated with coronary artery atherosclerosis. If cerebrovascular disease, vascular complications of diabetes, & other vascular diseases are included, the figure is over 40%. After age 40 the lifetime risk for developing symptomatic coronary artery disease is 50% in men & 40% in women.
or complete obstruction • Depending on the degree & character of
the obstruction
– angina pectoris – MI – sudden cardiac death – chronic ischemic heart disease with CHF
Diseases of the Heart
Major Determinants of Disease
• Most heart disease is the result of atherosclerotic obstruction of the coronary arteries
• Congestive heart failure is mechanical failure of the heart to eject blood delivered to it
• Premature ventricular contractions
– occur in healthy people – chest palpitations & anxiety
• Ventricular tachycardia
– spontaneous, regular beating at > 120 beats/min
• Each year heart disease accounts for about 1/3 of deaths in the US, most of which are associated with coronary artery atherosclerosis. If cerebrovascular disease, vascular complications of diabetes, & other vascular diseases are included, the figure is over 40%. After age 40 the lifetime risk for developing symptomatic coronary artery disease is 50% in men & 40% in women.
高血压英文PPT精品课件Cardiovascular
Myocarditis Morphology
• Gross –dilated, flabby heart, pale patches with hemorrhage
• Microscopic – interstitial inflammatory infiltrate with myocyte necrosis, fibrosis
– Dilated Cardiomyopathy – Hypertrophic Cardiomyopathy – Restrictive Cardiomyopathy
Congestive Heart Failure
• Cardiac output insufficient for metabolic requirements of the body
Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy – myofiber dysarray – not all fibers are pulling the same direction. Thus the contraction is ineffective. However, the cardiac conduction system can have these same problems, which might cause the arrhythmias and sudden death these patients tend to die of.
Cardiomyopathies
Dilated Cardiomyopathy
【高血压英文PPT精品课件】 Diseases of the Heart
• Each year heart disease accounts for about 1/3 of deaths in the US, most of which are associated with coronary artery atherosclerosis. If cerebrovascular disease, vascular complications of diabetes, & other vascular diseases are included, the figure is over 40%. After age 40 the lifetime risk for developing symptomatic coronary artery disease is 50% in men & 40% in women.
Diseases of the Heart
Major Determinants of Disease
• Most heart disease is the result of atherosclerotic obstruction of the coronary arteries
• Congestive heart failure is mechanical failure of the heart to eject blood delivered to it
• stress • lack of sleep • caffeine • some drugs
• Atrial flutter
– rapid, regular atrial rhythm – ~ 300 beats/min
• Atrial fibrillation
高血压英文PPT精品课件CardiovascularDiseasePreventive
Acceptable methods of treatment must be available for the condition (YES).
The condition must have an asymptomatic period during which detection and treatment significantly reduce morbidity or mortality (YES).
CAD screening and EKG (4)
Stress testing (EKG only) more sensitive and specific than resting EKG, but many false + (not specific enough Still, only 1-11% w/ abnormalities suffered
Atherosclerotic Vascular Disease
Risk Factors, Screening to Prevent
Athertery disease (CAD) Cerebrovascular disease CVD) Peripheral vascular disease (PVD) Reno-vascular dis. and renal failure (CRF) >> hypertension
Obesity, diabetes, hypertension and dyslipidemia
80%-90% of type II diabetics are obese Prevalence of obesity and of diabetes type II have risen in parallel since 1980. 33% increase in prevalence of D/M between 1990 and 1998
The condition must have an asymptomatic period during which detection and treatment significantly reduce morbidity or mortality (YES).
CAD screening and EKG (4)
Stress testing (EKG only) more sensitive and specific than resting EKG, but many false + (not specific enough Still, only 1-11% w/ abnormalities suffered
Atherosclerotic Vascular Disease
Risk Factors, Screening to Prevent
Athertery disease (CAD) Cerebrovascular disease CVD) Peripheral vascular disease (PVD) Reno-vascular dis. and renal failure (CRF) >> hypertension
Obesity, diabetes, hypertension and dyslipidemia
80%-90% of type II diabetics are obese Prevalence of obesity and of diabetes type II have risen in parallel since 1980. 33% increase in prevalence of D/M between 1990 and 1998
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CVD made up 16.7 million of global deaths in 2002, among which 7 million due to coronary heart disease, 6 million due to stroke
Distribution of types of CVD in global deaths : Global cardiovascular deaths in 2002: 16.7 million among which: coronary heart disease 7.2 million
4,7பைடு நூலகம் 14,9% 24,6%
55,8%
>65 yrs
external others cancer CVD
PROPORTION OF MORTALITY IN DIFFERENT AGE-GROUPS (WOMEN)
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
- Study of the natural history of CVD
- Formulation and testing of etiological hypotheses (risk factors)
- Contribution to the development of cardiovascular prevention programs and the measurement of their effectiveness
> stroke 6.0 million > 0.9 million hypertensive heart disease > 0.4 million inflammatory heart disease > 0.3 million rheumatic heart disease > 1.9 million other CVD
SDR: Standardized Death Rate
Direct mode of standardization, using the age distribution of a hypothetical European standard population
Premature death rates for comparison purposes (<64 years of age)
3., Experimental epidemiology/Interventions
= Strategies of cardiovascular prevention (primordial, primary, secondary, tertiary; individual and community levels)
Question: What is the relative amount of CVD in different geographical places? What are the time trends? International and regional characteristics of distribution
- Increase in CVD morbidity and mortality: in age-group of 30-44 years
- Premature death (<64 years of age, or 25-64 years): in the elderly population more difficult to interpret death rate due to multiple ill health causes
Public Health BETTINA PIKO, M.D., Ph.D.
- Leading cause of mortality in developed countries and a rising tendency in developing countries (disease of civilization)
1., Descriptive epidemiology:
= Describing distribution of cardiovascular disease by means of certain characteristics such as : PERSON (i.e., age, gender, ethnicity) TIME and PLACE
Developed countries: decreasing tendencies (e.g, USA: 30% between 1988-98, Sweden: 42%)
- improvement of lifestyle factors, for example, a decrease of smoking and a higher level of health consciousness in many developed countries
- Morbidity: nearly 30% of all disability cases
- Contributes to deterioration of the quality of life
- Coronary heart disease (CHD, ischemic heart disease, heart attack, myocardial infarction, angina pectoris)
- better diagnostic and therapeutic procedures (e.g., bypass surgeries, hypertension screening, pharmacological treatment of hypertension and hypercholesterinaemia, access to health care)
- In the US: increased cardiovascular disease deaths in African-American and South-Asian populations in comparison with Whites
- Increased stroke risk in African-American, some Hispanic American, Chinese, and Japanese populations
- A major impact on life expectancy
- Significantly contributes to morbidity and death rates in the middle aged population: potential life years lost, common cause of premature death, labor force (economic costs), family life
- Cerebrovascular disease (stroke, TIA, transient ischemic attack)
- Hypertensive heart disease
- Peripheral vascular disease
- Heart failure
- Rheumatic heart disease (streptococcal infection)
40,0%
35,0%
17,7% 7,3%
1-24 yrs
8,2% 24,0% 36,5%
31,3%
25-64 yrs
4,8% 18,3% 12,2%
64,7%
>65 yrs
external others cancer
CVD
Question: What is the relative amount of CVD in death rates in women and men?
- Migration: Ni-Hon-San Study: Japanese living in Japan had the lowest rates of CHD and cholesterol levels, those living in Hawaii had intermediate rates for both, those living in San Francisco had the highest rates for both
- Women: special case (WHO, 2004)
a., Higher risk in women than men (smoking, high triglyceride levels)
b., Higher prevalence of certain risk factors in women (diabetes mellitus, depression)
c., Gender-specific risk factors (risks for women only) (oral contraceptives, hormone replacement therapy, polycystic ovary syndrome)
Question: What is the relative amount of CVD in death rates in different ethnic groups?
Question: What is the relative amount of CVD in death rates in different age groups?
- Early lesions of blood vessel, atherosclerotic plaques: around 20 years - adult lifestyle patterns usually start in childhood and youth (smoking, dietary habits, sporting behavior, etc.)
Distribution of types of CVD in global deaths : Global cardiovascular deaths in 2002: 16.7 million among which: coronary heart disease 7.2 million
4,7பைடு நூலகம் 14,9% 24,6%
55,8%
>65 yrs
external others cancer CVD
PROPORTION OF MORTALITY IN DIFFERENT AGE-GROUPS (WOMEN)
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
- Study of the natural history of CVD
- Formulation and testing of etiological hypotheses (risk factors)
- Contribution to the development of cardiovascular prevention programs and the measurement of their effectiveness
> stroke 6.0 million > 0.9 million hypertensive heart disease > 0.4 million inflammatory heart disease > 0.3 million rheumatic heart disease > 1.9 million other CVD
SDR: Standardized Death Rate
Direct mode of standardization, using the age distribution of a hypothetical European standard population
Premature death rates for comparison purposes (<64 years of age)
3., Experimental epidemiology/Interventions
= Strategies of cardiovascular prevention (primordial, primary, secondary, tertiary; individual and community levels)
Question: What is the relative amount of CVD in different geographical places? What are the time trends? International and regional characteristics of distribution
- Increase in CVD morbidity and mortality: in age-group of 30-44 years
- Premature death (<64 years of age, or 25-64 years): in the elderly population more difficult to interpret death rate due to multiple ill health causes
Public Health BETTINA PIKO, M.D., Ph.D.
- Leading cause of mortality in developed countries and a rising tendency in developing countries (disease of civilization)
1., Descriptive epidemiology:
= Describing distribution of cardiovascular disease by means of certain characteristics such as : PERSON (i.e., age, gender, ethnicity) TIME and PLACE
Developed countries: decreasing tendencies (e.g, USA: 30% between 1988-98, Sweden: 42%)
- improvement of lifestyle factors, for example, a decrease of smoking and a higher level of health consciousness in many developed countries
- Morbidity: nearly 30% of all disability cases
- Contributes to deterioration of the quality of life
- Coronary heart disease (CHD, ischemic heart disease, heart attack, myocardial infarction, angina pectoris)
- better diagnostic and therapeutic procedures (e.g., bypass surgeries, hypertension screening, pharmacological treatment of hypertension and hypercholesterinaemia, access to health care)
- In the US: increased cardiovascular disease deaths in African-American and South-Asian populations in comparison with Whites
- Increased stroke risk in African-American, some Hispanic American, Chinese, and Japanese populations
- A major impact on life expectancy
- Significantly contributes to morbidity and death rates in the middle aged population: potential life years lost, common cause of premature death, labor force (economic costs), family life
- Cerebrovascular disease (stroke, TIA, transient ischemic attack)
- Hypertensive heart disease
- Peripheral vascular disease
- Heart failure
- Rheumatic heart disease (streptococcal infection)
40,0%
35,0%
17,7% 7,3%
1-24 yrs
8,2% 24,0% 36,5%
31,3%
25-64 yrs
4,8% 18,3% 12,2%
64,7%
>65 yrs
external others cancer
CVD
Question: What is the relative amount of CVD in death rates in women and men?
- Migration: Ni-Hon-San Study: Japanese living in Japan had the lowest rates of CHD and cholesterol levels, those living in Hawaii had intermediate rates for both, those living in San Francisco had the highest rates for both
- Women: special case (WHO, 2004)
a., Higher risk in women than men (smoking, high triglyceride levels)
b., Higher prevalence of certain risk factors in women (diabetes mellitus, depression)
c., Gender-specific risk factors (risks for women only) (oral contraceptives, hormone replacement therapy, polycystic ovary syndrome)
Question: What is the relative amount of CVD in death rates in different ethnic groups?
Question: What is the relative amount of CVD in death rates in different age groups?
- Early lesions of blood vessel, atherosclerotic plaques: around 20 years - adult lifestyle patterns usually start in childhood and youth (smoking, dietary habits, sporting behavior, etc.)