老年高血压诊治进展课件.ppt

1、老年高血压老年高血压脉压差和动脉粥样硬化之间的关系脉压差和动脉粥样硬化之间的关系脉压脉压血管内皮损伤血管内皮损伤及机械性疲劳及机械性疲劳动脉硬化动脉硬化主动脉僵硬主动脉僵硬中心脉搏波反射中心脉搏波反射 Figure 1年轻人年轻人老年人老年人Figure 1D D LVLAPStrokeStrokeLVHLVHCoronary Coronary Events(MI.)Events(MI.)左室负荷增加左室负荷增加舒张期冠脉灌注压降低舒张期冠脉灌注压降低The CAFE investigators.Differential impact of blood pressure-lowering dr

2、ugs on central aortic pressure and clinical outcomes.Principal results of the Conduit Artery Function Evaluation(CAF)study.Circulation.2006,113:1213-1225.Decrease in the central Aortic BP was linked to significant reduction in CV eventsAmlodipine+AcertilAtenolol+thiazidetLPWVDDtLPWVDDtLPWVDDLD 肾血流增龄

3、性改变与高血压肾血流增龄性改变与高血压 全国全国13个省市糖尿病患病率与年龄的关系个省市糖尿病患病率与年龄的关系40岁以上糖尿病患者占其总数的岁以上糖尿病患者占其总数的87.06%.。女性高峰在。女性高峰在60岁组，为岁组，为43.34%，男性高峰在男性高峰在70岁组，为岁组，为46.91%100+909980897579707470120120139140159160+48.320.610.311.88.88.59.223.816.913.912.812.611.831.025.524.625.325.224.937.434.743.838.180.6 NT=NT=正常血压正常血压IDH=I

4、DH=单纯舒张期高血压单纯舒张期高血压SDH=SDH=舒张压收缩压均增高舒张压收缩压均增高ISH=ISH=单纯收缩期高血压单纯收缩期高血压Adjusted relative risk of stroke according to categories of baseline blood pressure in the subjects for the Copenhagen City Heart Study.Am J Hypertens 1997;10:634SHEP(Systolic Hypertension in the elderly)SHEP(Systolic Hypertension

5、in the elderly)试验试验ACB舒张压舒张压心血管疾病风险心血管疾病风险DBP65-80 mmHg舒张压与心血管危险之间的关系舒张压与心血管危险之间的关系流行病学流行病学HOT INVEST血压形态与心血管事件血压形态与心血管事件Rothwell PM,et al.Stroke,2003 Nov;34(11),2583-2590.颈动脉狭窄程度与血压水平的相对危险性分析颈动脉狭窄程度与血压水平的相对危险性分析Rothwell PM,et al.Stroke,2003 Nov;34(11),2583-2590.颈动脉狭窄程度与血压水平的相对危险性分析颈动脉狭窄程度与血压水平的相对危险

6、性分析Rothwell PM,et al.Stroke,2003 Nov;34(11),2583-2590.颈动脉狭窄程度与血压水平的相对危险性分析颈动脉狭窄程度与血压水平的相对危险性分析颈动脉狭窄时的血压调控目标颈动脉狭窄时的血压调控目标N.Beckett,R.Peters,A.Fletcher,C.Bulpitt on behalf of the HYVET committees and investigatorsClinicalTrials.gov:NCT00122811International,multi-centre,randomised double-International,

7、multi-centre,randomised double-blind placebo controlledblind placebo controlledInclusion CriteriaInclusion Criteria Aged 80 or more,Aged 80 or more,Systolic BP160-199mmHg+diastolic BP110 mmHgSystolic BP160-199mmHg+diastolic BP110 mmHgTarget blood pressure 150/80 mmHg19331912Median follow-up 1.8 years15 mmHg 6 mmHg All stroke(30%reduction)P=0.055Total Mortality(21%reduction)P=0.019Fatal Stroke(39%reduction)P=0.046Heart Failure(64%reduction)P0.0001020.50.20.1 ITT Summary