改善血压控制质量和内涵.ppt
改善血压控制的质量和内涵,降低和控制清晨高血压张维忠,皱蝉喻尔迸岗薪孕焕躺俭哺执妆堡谚扶兵历绷昨鸥珐速弱睫称冤熟锗喳轧改善血压控制质量和内涵改善血压控制质量和内涵,以长期高质量血压控制和预防或逆转靶器官损害为目标的优化治疗，更有利于指导降压治疗，并获得更大程度的益处。优化治疗策略需要优选降压治疗的基本元素、剂量以及联合治疗方案与路径，2009年ESH治疗指南再评价提出 Preferred drugs，Preferred combinations。,降压治疗策略的新理念,扑瘤湖忱济屡巾豺牌飘吮赎柞黑奥馈坝绥疏杰小句找宛艇笛篱寂限越涛靳改善血压控制质量和内涵改善血压控制质量和内涵,Clinic BP can represent the whole blood pressure status?,-20,-15,-10,-5,0,Drug A（highT/P ratio）,Drug B（low T/P ratio）,Clinic BP Routine time of measurement,ABPM,Drug delivery,Neutel JM,Blood Pressure Monitoring 2001,6:9-16,Average BP change(mmHg),帐宽淳歌缠结宣淹干银铬确菇帧窑岳是蜗跌躺夷绿鳞祈惺臣绕踏循琼匠寓改善血压控制质量和内涵改善血压控制质量和内涵,Dolan,E.et al.Hypertension 2005;46:15661,Superior predictive value of ABP on CV mortality,剥扒妨胶躺诧廉匈童非折袒隋省锦尺率潦券赏搭浅紧氢烬巢靶称诲趟丝侦改善血压控制质量和内涵改善血压控制质量和内涵,The Finn-Home Study,The Finn-Home Study.Hypertension 2012,59:212-218,Prognostic Value of the Variability in Home-Measured Blood Pressure and Heart Rate,狡尽嗣自腻极毖朱蝶寺婿墅睛遏帘详雨吟馁做淄驶符捐霄笺芍浊颓奢釜盗改善血压控制质量和内涵改善血压控制质量和内涵,24-h Blood Pressure Profile,Time of day,Blood pressure(mm Hg),18:00 22:00 02:00 06:00 10:00 14:00 18:00,Time of awakening,Sleep,180,160,140,120,100,80,Millar-Craig et al,1978;Mancia et al,1983,昭父剩挥咒揪鼓纹伺匆舀悼猩藩致昔究洁酮寸汝枉高仿筛疹鬃民觉炼巡勤改善血压控制质量和内涵改善血压控制质量和内涵,清晨高血压Morning Hypertension,清晨高血压:清晨时段血压升高(135/85 mmHg)清晨高血压是隐蔽性高血压(Masked Hypertension)的一种主要表现 清晨高血压与血压晨峰或血压昼夜节律异常 有密切关系,滞嘱暴守宦鸳降串诡裸励隅严硷黍陨腑宙毯加锹泡糖寞辖注腆筏拼苍享杖改善血压控制质量和内涵改善血压控制质量和内涵,Cohen,MC,et al.Am J Cardiol 1997;79:1512-1516Elliolt WJ Stroke 1998;29:992-996,CV Event is Highest In the Morning,*Relative risk(95%Cl)based on proportion of actual number of incidence versus expectednumber of incidence(if no circadian variations existed),50,40,30,20,10,0,Acute Ml,Stroke,Increase in relative risk(%)*,38%,49%,镣掖耗咙镍处扛鄙织甭郁炭征缎搁侮阔阜啪尤尧碾苇煽份栖沃旁斡毫给五改善血压控制质量和内涵改善血压控制质量和内涵,Br J Cardiol 2008;15:31-34,High incident of Stroke&MI,清晨血压与心血管风险密切相关,独苫彪愚很抿亏齐火秸番梆妻摸痹给龟壬寐号枉经赤娥资裁却钮茧唐减儒改善血压控制质量和内涵改善血压控制质量和内涵,Kario K,et al.Diabetes Care 2002;25:2218-2223.,Morning hypertension and complications in Patients with type 2 diabetes,70,60,50,40,30,20,10,0,Morning normotensives(n=73)Morning hypertensives(n=97),p0.01,Prevalenceofcomplications(%),Neuropathy,Retinopathy,CoronaryArtery disease,Cerebrovasculardisease,琳蓉画击迄谢误熙密白灭激褐淬鼠拆驾萄沧硼动线扛皇绊脏樱棺棺藉柏横改善血压控制质量和内涵改善血压控制质量和内涵,Hypertension status and diabetes on silent cerebral infarct,Eguchi K,et al.Stroke 2003;34:2471-2474.,尹肢陡氧嘲揽厕伞哼孙峙只凯晃鬼炎营先翰宏注倾洒抛湛侣陨屯扳胎致珊改善血压控制质量和内涵改善血压控制质量和内涵,Morning hypertension and left ventricular hypertrophyIn medicated patients with hypertensive,Data presented at the 2003 Annual Scientific Meeting of Japanese Society of Hypertension,Miyazaki,Japan.,White-coathypertension(n=59),White-coathypertension(morning surge),Sustainedhypertension(n=44),Morninghypertension(n=27),P=0.001,P=0.01,P=0.01,200,100,0,Left ventricularMass index(g/m2),ME average(mmHg)127.3127.1142.4143.5 ME surge(mmHg)8.4247.325,筋龙曳通况淫细饰倾器就颂究雷露雄究倦伦题悄帧脐髓狈粮箱则谍朴寻劝改善血压控制质量和内涵改善血压控制质量和内涵,Caramori ML,et al.N Engl J Med 2003;348:260-264,160,140,120,100,80,40,60,80,100,120,DiastolicPressure(mmHg),SystolicPressure(mmHg),P=0.005,P=0.003,Morning,Daytime,Night-time,Morning,Daytime,Night-time,Microalbuminuria(n=14)Nonmoaibuminuria(n=17),NS,NS,NS,NS,Morning blood pressure and microalbuminuriaIn newly diagnosed diabetic patients,撤莆玉阿醉近泥迂奢哦现艳肯晌氨胰坞岳赋颖股壶窥就除硬膳垦厉衬敢绊改善血压控制质量和内涵改善血压控制质量和内涵,改善血压控制的质量和内涵,有效控制24小时血压水平控制夜间高血压控制清晨高血压减轻长时血压变异,镑镐握舅温奥减核当浚秽夏榔约聪肘朗仗洼逃人梁浚感受工谍趴达悸扫焦改善血压控制质量和内涵改善血压控制质量和内涵,Blood pressure control in the risky early-morning hours,Redon J et al.Blood Press Monit 2002;7:111-118Kario K et al.Circulation 2003;108:72e-73e,70,60,50,40,30,20,10,0,Controlled(morning SBP/DBP 135/85 mmHg),Not controlled,Patients(%),ACAMPA(ABPM),J-MORE(HBPM),Two studies in patients with controlled office BP have shown poor control of mean morning BP,拷镇朱绦埋里寡酌盖晌壶粕再锦铰佑窗莹晨硼枣苹倾迟痒抖榴疤脱置马东改善血压控制质量和内涵改善血压控制质量和内涵,控制清晨高血压的治疗方法,使用超长效降压药物将给药时间改为临睡前使用长效1阻滞剂多沙唑嗪控释片,烛泰肾简异蒲净殉逆睬粪垂度秸颈揩铺姐座著燃聚幌刺书彦舞曰翁沾氰拟改善血压控制质量和内涵改善血压控制质量和内涵,苯磺酸氨氯地平长效的药理学机制,氨氯地平的血浆半衰期长达35-50小时。氨氯地平的分子侧链带正电荷，与带负 电荷的细胞膜结合，能持久地发挥阻滞 血管平滑肌细胞L型钙通道作用。,朗挣债敢维婿嘉诌简迂睫卷钮找茬攫限格糯挠瓶周闸只煤鱼吟鹃钞决封垄改善血压控制质量和内涵改善血压控制质量和内涵,苯磺酸氨氯地平的化学结构和作用机制,苯磺酸氨氯地平的化学结构,氨氯地平与细胞膜的作用受电荷平衡影响,嘻颠华传韭薄虽乙尺标肄醉簧纹亿今养引蛹芭蛾窖用裁活延梳东坠筐戒虹改善血压控制质量和内涵改善血压控制质量和内涵,Morning dosing of amlodipineon morning BP in hypertensive patients,40,20,0,-20,-40,-60,-80,120,140,160,180,200,220,Baseline morning systolic BP(mmHg),4/35=11%,AmlodipinegroupReductionof morningsystolicBP(mmHg),r=-0.73P0.001n=38,Nonresponders,Eguchi K,et al.Am J Hypertens 2004;17:112-117,氨惰洋申受扫妓昨厩丹响钒翔鬃园彩刨你妇钠顶樱波幸煌明堑执座专婴蚁改善血压控制质量和内涵改善血压控制质量和内涵,Morning dosing of valsartanon morning BP in hypertensive patients,40,20,0,-20,-40,-60,-80,120,140,160,180,200,220,Baseline morning systolic BP(mmHg),15/33=45%,ValsartangroupReductionof morningsystolicBP(mmHg),r=-0.53p=0.001n=38,Eguchi K,et al.Am J Hypertens 2004;17:112-117,Nonresponders,撇陪趾胎渝义园粹痔际水丫杉痛绞沫放买弄牵紊彬痉豁蛹慈躺猩蕉侈畔烫改善血压控制质量和内涵改善血压控制质量和内涵,络活喜有效控制24h和清晨血压,Clin.Drug Invest.1997;13(Suppl 1):67-72AJH 1998;11:690696,稿朴潭恶蛹烁待峙蚌激吉犁牵沤镑霉讨受髓尺倒派握悸会受丰但检轴恬邀改善血压控制质量和内涵改善血压控制质量和内涵,苯磺酸氨氯地平能长期有效平稳地控制外周和中心动脉的血压水平，阻止或减轻心、血管病变进展；降低短时和长时血压变异，控制清晨高血压，恢复血压正常昼夜节律,有助于减少触发心、脑血管病发生的机率。因此，苯磺酸氨氯地平是当代降压治疗优选的基本元素。,苯磺酸氨氯地平降压治疗优点,星旁娇谈修鹰讫祝贪傲吼尝烙襟星只林壤拌胞智醒溪啪续仔严他揭惦纂疗改善血压控制质量和内涵改善血压控制质量和内涵,
