农村高血压脑卒中现状发病趋势及干预措施课件.ppt

1、Shengjing Hospital of China Medical UniversityShengjing Hospital of China Medical UniversityScreening PatientsN=6516Health Education（N=2499）Intervention Model：AElementary Intervention（N=2139）Intervention Model：A+BGeneral Intervention（N=1878）Intervention Model：A+B+CShengjing Hospital of China Medical

2、 UniversityA A：Health educationHealth education；B B：Antihypertensive medication Antihypertensive medication C C：Lowering-lipid therapyLowering-lipid therapy HydrochlorothiazideHydrochlorothiazide Invalid,+NitrendipineNitrendipineShengjing Hospital of China Medical UniversityStarting Medication 1 mon

3、th later3 months later 5 months later Invalid,+NitrendipineNitrendipine (double)(double)Invalid,+CaptoprilShengjing Hospital of China Medical University55.8010.83 yearsShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical Univ

4、ersityShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical UniversityTotal control rate:31.8%31.8%P=0.181Shengjing Hospital of China Medical University55.049.84 yearsShengjing Hospital of China Medical UniversityShengjing Hos

5、pital of China Medical UniversityShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical U

6、niversityPreHT V.S Normal:RR:1.432(95CI%1.342-1.529)PreHT V.S Normal:RR:Men:1.341(95CI%1.221-1.472);Women:1.463(95CI%1.335-1.603)PreHT V.S Normal:RR:35-44 yrs,1.344(1.208-1.494);45-54 yrs,1.379(1.229-1.548);55-64 yrs,1.337(1.155-1.549);65 yrs,1.448(1.187-1.766);Log-rank test:P0.0001Shengjing Hospita

7、l of China Medical University015014514013513012345609085807570123456随访(年)随访(年)平均收缩压平均舒张压mmHgmmHg氯噻酮氨氯地平赖诺谱利 随访期间每年收缩压和舒张压的情况与氯噻酮组相比，氨氯地平组收缩压高0.8mmHg(P=0.03)，赖诺普利组高 2mmHg(P0.001)；氨氯地平组舒张压低0.8mmHg(P0.001)。赖诺普利在老年人收缩压较氯噻酮组高3mmHg，在黑人高4mmHg。脑卒中 1氯噻酮 赖诺普利 氨氯地平 2345624681007累积事件发生率 事件发生时间（率）氯噻酮 氨氯地平 赖诺普利 1

8、5255904890541451586178543139348271817213309794977841157069376765638538453891321718131828567506949有风险病人数目 总死亡率 氯噻酮 氨氯地平 赖诺普利 15255904890541493388478853145648654861214077839183181248074427382718543124304352321012121428217144有风险病人数目 1氯噻酮 氨氯地平 赖诺普利 2345651015202507累积事件发生率 事件发生时间（率）30Dahlf B et al Lancet

9、 2002;359:995-1003.发生首次事件的患者比例发生首次事件的患者比例(%)0246810121416心血管死亡、脑卒中和心肌梗塞的复合终点心血管死亡、脑卒中和心肌梗塞的复合终点氯沙坦氯沙坦阿替洛尔阿替洛尔研究月份研究月份0612182430364248546066氯沙坦氯沙坦(n)46054524446043924312424741894112404738971889901阿替洛尔阿替洛尔(n)45884494441443494289420541354066399238211854876校正后危险性下降校正后危险性下降 13.0%,p=0.021未校正危险性下降未校正危险性下降 14.6%,p=0.00913%P=0.021方框表示该类药物在对照干预研究中被证实可带来获益方框表示该类药物在对照干预研究中被证实可带来获益噻嗪类利尿剂噻嗪类利尿剂ARB钙拮抗剂钙拮抗剂ACEI-阻滞剂阻滞剂-阻滞剂阻滞剂Shengjing Hospital of China Medical UniversityShengjing Hospital of China Medical UniversityShengjing Hospital of China Medical University