降压治疗的策略和目标
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降压治疗策略与目标
回顾与进展
降压治疗策略研究的重点
? 血压水平与心血管危险 ? 降压治疗与心血管危险控制
治疗益处及来源 (why) 治疗对象 (who) 治疗目标水平 (what) 治疗方案 (which)
血压、年龄与脑卒中死亡率(100万人群资料分析)
A: Systolic blood pressure
IHD
40-49
1322
50-59
5594
60-69 70-79
10450 10852
80-89
5649
0.49 (0.45-0.53) 0.50 (0.49-0.52) 0.54 (0.53-0.55) 0.60 (0.58-0.61) 0.67 (0.64-0.70)
Other vascular
40-49 50-59 60-69 70-79 80-89
386 1377 2549 3227 2251
0.43 (0.38-0.48) 0.50 (0.47-0.54) 0.53 (0.51-0.56) 0.64 (0.61-0.67) 0.70 (0.65-0.75)
Lancet 2002,360:1903
Cause Of death
Age at risk(years)
Number of deaths
Stroke
40-49 50-59 60-69 70-79 80-89
414 1372 2939 4327 2636
0.36 (0.32-0.40) 0.38 (0.35-0.40) 0.43 (0.41-0.45) 0.50 (0.48-0.52) 0.67 (0.63-0.71)
5068
0.35 (0.30-0.40) 0.34 (0.32-0.37) 0.40 (0.38-0.42) 0.48 (0.45-0.51) 0.63 (0.58-0.69)
0.47 (0.43-0.51) 0.52 (0.50-0.55) 0.56 (0.54-0.58) 0.62 (0.60-0.64) 0.70 (0.65-0.74)
93% 73% 43% 97% 100%
Lancet 2002,360:1903
ESRD危险性随血压升高而增加
血压分级
患者 ESRD数目 年龄校正后的 校正后的RR
(n = 322554) (n = 814) 每10万人年发生率 (95%CI)
Usual sysytolic blood Pressure (mmHg)
70 80 90 100 110
Usual diastolic blood Pressure (mmHg)
血压、年龄与冠心病死亡率(100万人群资料分析)
A: Systolic blood pressure
256
CI) 128
256
CI) 128
%
95 64
ortality
and risk
32
m Stroke
absolute
(floating
16 8 4
2
1
Age at rist: 80-89 Years 70-79 Yaes 60-69 years 50-59 Years
120
Lancet 2002,360:1903
140 160 180
Cause Of death
Age at risk(years)
Number of deaths
Stroke
40-49 50-59 60-69 70-79 80-89
348 1243 2646 3915 2340
IHD
40-49
1114
50-59
4945
60-69
9289
70-79
9727
80-89
0.25 0.35 0.5 0.7 1.0
Hazard ratio (95% CI) for 20 mmHg Lower usual systolic blood pressure
舒张压 10 mmHg 差值对心血管危险影响
B: usual diastolic blood pressure (? 75 mmHg)
Other vascular
40-49 50-59 60-69 70-79 80-89
Lancet 2002,360:1903
316 1140 2220 2853 1976
0.43 (0.37-0.50) 0.48 (0.44-0.52) 0.49 (0.46-0.53) 0.61 (0.57-0.66) 0.71 (0.64-0.79)
0.25 0.35 0.5 0.7 1.0
Hazard ratio (95% CI) for 10 mmHg Lower usual diastolic blood pressure
血压参数预测脑卒中和冠心病死亡率的相对能力
脑卒中
冠心病
SBP DBP PP MAP Mid BP
89% 83% 37% 100% 100%
256
CI) 128
%
95 64
ortality
and risk
32
m Stroke
absolute
(floating
16 8 4
2
1
Age at rist:
80-89 Years 70-79 Yaes 60-69 years 50-59 Years
B: Diastolic blood pressure
140 160 180
Usual sysytolic blood Pressure (mmHg)
70 80 90 100 110
Usual diastolic blood Pressure (mmHg)
收缩压 20 mmHg 差值对心血管危险影响
A: usual systolic blood pressure (?115 mmHg)
256
CI) 128
%
95 64
ortality m D IH
and risk absolute
(floating
32 16
8 4
2
1
Age at rist: 80-89 Years
70-79 Yaes
60-69 years
50-59 Years
40-49 years
120
Lancet 2002,360:1903
%
95 64
ortality m D IH
and risk absolute
(floating
32 16
8 4
2
1Leabharlann Baidu
Age at rist: 80-89 Years
70-79 Yaes
60-69 years
50-59 Years
40-49 years
B: Diastolic blood pressure
回顾与进展
降压治疗策略研究的重点
? 血压水平与心血管危险 ? 降压治疗与心血管危险控制
治疗益处及来源 (why) 治疗对象 (who) 治疗目标水平 (what) 治疗方案 (which)
血压、年龄与脑卒中死亡率(100万人群资料分析)
A: Systolic blood pressure
IHD
40-49
1322
50-59
5594
60-69 70-79
10450 10852
80-89
5649
0.49 (0.45-0.53) 0.50 (0.49-0.52) 0.54 (0.53-0.55) 0.60 (0.58-0.61) 0.67 (0.64-0.70)
Other vascular
40-49 50-59 60-69 70-79 80-89
386 1377 2549 3227 2251
0.43 (0.38-0.48) 0.50 (0.47-0.54) 0.53 (0.51-0.56) 0.64 (0.61-0.67) 0.70 (0.65-0.75)
Lancet 2002,360:1903
Cause Of death
Age at risk(years)
Number of deaths
Stroke
40-49 50-59 60-69 70-79 80-89
414 1372 2939 4327 2636
0.36 (0.32-0.40) 0.38 (0.35-0.40) 0.43 (0.41-0.45) 0.50 (0.48-0.52) 0.67 (0.63-0.71)
5068
0.35 (0.30-0.40) 0.34 (0.32-0.37) 0.40 (0.38-0.42) 0.48 (0.45-0.51) 0.63 (0.58-0.69)
0.47 (0.43-0.51) 0.52 (0.50-0.55) 0.56 (0.54-0.58) 0.62 (0.60-0.64) 0.70 (0.65-0.74)
93% 73% 43% 97% 100%
Lancet 2002,360:1903
ESRD危险性随血压升高而增加
血压分级
患者 ESRD数目 年龄校正后的 校正后的RR
(n = 322554) (n = 814) 每10万人年发生率 (95%CI)
Usual sysytolic blood Pressure (mmHg)
70 80 90 100 110
Usual diastolic blood Pressure (mmHg)
血压、年龄与冠心病死亡率(100万人群资料分析)
A: Systolic blood pressure
256
CI) 128
256
CI) 128
%
95 64
ortality
and risk
32
m Stroke
absolute
(floating
16 8 4
2
1
Age at rist: 80-89 Years 70-79 Yaes 60-69 years 50-59 Years
120
Lancet 2002,360:1903
140 160 180
Cause Of death
Age at risk(years)
Number of deaths
Stroke
40-49 50-59 60-69 70-79 80-89
348 1243 2646 3915 2340
IHD
40-49
1114
50-59
4945
60-69
9289
70-79
9727
80-89
0.25 0.35 0.5 0.7 1.0
Hazard ratio (95% CI) for 20 mmHg Lower usual systolic blood pressure
舒张压 10 mmHg 差值对心血管危险影响
B: usual diastolic blood pressure (? 75 mmHg)
Other vascular
40-49 50-59 60-69 70-79 80-89
Lancet 2002,360:1903
316 1140 2220 2853 1976
0.43 (0.37-0.50) 0.48 (0.44-0.52) 0.49 (0.46-0.53) 0.61 (0.57-0.66) 0.71 (0.64-0.79)
0.25 0.35 0.5 0.7 1.0
Hazard ratio (95% CI) for 10 mmHg Lower usual diastolic blood pressure
血压参数预测脑卒中和冠心病死亡率的相对能力
脑卒中
冠心病
SBP DBP PP MAP Mid BP
89% 83% 37% 100% 100%
256
CI) 128
%
95 64
ortality
and risk
32
m Stroke
absolute
(floating
16 8 4
2
1
Age at rist:
80-89 Years 70-79 Yaes 60-69 years 50-59 Years
B: Diastolic blood pressure
140 160 180
Usual sysytolic blood Pressure (mmHg)
70 80 90 100 110
Usual diastolic blood Pressure (mmHg)
收缩压 20 mmHg 差值对心血管危险影响
A: usual systolic blood pressure (?115 mmHg)
256
CI) 128
%
95 64
ortality m D IH
and risk absolute
(floating
32 16
8 4
2
1
Age at rist: 80-89 Years
70-79 Yaes
60-69 years
50-59 Years
40-49 years
120
Lancet 2002,360:1903
%
95 64
ortality m D IH
and risk absolute
(floating
32 16
8 4
2
1Leabharlann Baidu
Age at rist: 80-89 Years
70-79 Yaes
60-69 years
50-59 Years
40-49 years
B: Diastolic blood pressure