中国高血压防治指南培训手册.ppt

D Definitionefinition Hypertension is defined as a SBP of Hypertension is defined as a SBP of 140 mmHg or greater and/or a DBP of 90 140 mmHg or greater and/or a DBP of 90 mmHg or greater in subjects who are mmHg or greater in subjects who are not taking antihypertensive medication.not taking antihypertensive medication.95%Essential or primary hypertension95%Essential or primary hypertension 5%Secondary hypertension 5%Secondary hypertension EpidemiologyPrevalence rate（患病率）（患病率）of hypertension in China:In 1959-5.11%In 1979-7.73%In 1991-11.88%In 2004-18.80%The prevalence of high BP increases with age.Hypertension is more common in men than in women up to age 50,after that age,hypertension is more common in women.Hypertension is more common in northern China than in southern China.Etiology and pathogenesis of EHEtiology and pathogenesis of EH No cause can be established Possible factors Genetic tendency Spontaneous hypertension rat EH tends to cluster in families Environemnts 高血压高血压遗遗 传传 环环 境境 高高 盐盐 饮饮 食食肥胖肥胖精神压力过重精神压力过重饮饮 酒酒体育锻炼少体育锻炼少 Pathogenesis of EHPathogenesis of EH sympathetic nervous system activity RAAS 肾脏潴钠肾脏潴钠 Vessel remolding Vascular endothelium dysfunction nitric oxide endothelin Insulin resistance(胰岛素抵抗胰岛素抵抗)sodium reabsorption,sympathetic nervous system activity,intracellular Na Ca 病病 理理 血管：全身细小动脉病变血管：全身细小动脉病变大中大中动脉病变动脉病变 心：左心室后负荷增加心：左心室后负荷增加心肌肥厚心肌肥厚 与扩大与扩大心力衰竭；动脉粥样硬化心力衰竭；动脉粥样硬化 脑：脑小动脉硬化。脑血栓、脑出血、脑：脑小动脉硬化。脑血栓、脑出血、脑水肿脑水肿 肾：肾细小动脉硬化。肾单位萎缩肾：肾细小动脉硬化。肾单位萎缩 肾功能衰竭肾功能衰竭Clinical findingsClinical findingsBPBP波动波动-，White coat EHWhite coat EHSymptoms-Symptoms-Mild to moderate EH is usually associated with normal health for many years.Some patients have headache,tinnitus（耳鸣）耳鸣）,palpitation,tiredness（疲劳）疲劳）,and so on.Signs-Signs-BP is elevated.Some patients have a loud aortic second sound and an early systolic ejection click(收缩期喷射喀喇音收缩期喷射喀喇音).).Clinical findingsClinical findings(Continue)(Continue)Complications:Hypertensive cardiovascular disease,CHD Hypertensive cerebrovascular disease Hypertension is the major predisposing cause of stroke.Hypertensive renal disease Chronic hypertension leads to nephrosclerosis(肾肾硬化症硬化症)Aortic dissection（主动脉夹层）（主动脉夹层）blood pressure measurementblood pressure measurement WHOWHO不同测量方法的高血压定义不同测量方法的高血压定义 SBP DBPSBP DBP 诊室偶测血压诊室偶测血压 140 90 140 90 在家测量血压在家测量血压 135 85 135 852424小时动态测压小时动态测压 130 80 130 80 Normal reference of ABPM(24h Daytime Nighttime SBP DBP SBP DBP SBP DBPStaessen 133 82 140 88 125 76JNC-7 135 85 120 75China3 130 80 135 85 125 75 Routine investigationsUrinalysis（尿液检查）（尿液检查）Serum potassium,BUN（尿素氮（尿素氮),Cr（肌（肌苷苷),Serum uric acid(尿酸尿酸),Fasting glucose,Plasma cholesterol,and so on.ECGUCG ventricular hypertrophyChest X-ray ventricular enlargementFunduscopic examination retina arteriolar narrowing arteriovenous nicking(动静脉交叉压迫动静脉交叉压迫)hemorrhage,exudate(渗出渗出)papilledema(视神经乳头水肿视神经乳头水肿)Diagnosis&differential diagnosisDiagnosis&differential diagnosisTo confirm a chronic elevation of blood pressure and determine its levelTo identify secondary causes of hypertension To determine the presence of target-organ damage and to quantify its extentTo search for other cardiovascular risk factors&clinical conditions that may influence prognosis&treatmentC Classification of Blood Pressure Levels(mmHg)lassification of Blood Pressure Levels(mmHg)Category Systolic DiastolicOptimal 120 80Normal 130 85High-normal 130-139 85-89Grade 1 hypertension(mild)140-159 90-99 Subgroup:borderline 140-149 90-94Grade 2 hypertension(moderate)160-179 100-109Grade 3 hypertension(severe)180 110 Isolated systolic hypertension 140 90 Subgroup:borderline 140-149 90 2003 美国美国JNC-7 血压水平分类血压水平分类正常正常120和和160或或100血压分类血压分类收缩压收缩压mmHg舒张压舒张压mmHg中国中国2004高血压指南高血压指南 类类 别别 收缩压收缩压(mmHg)舒张压舒张压(mmHg)正常血压正常血压 120 80 正常高值正常高值 120139 8089 高血压高血压 140 90 1级高血压（轻度级高血压（轻度)140159 9099 2级高血压级高血压(中度中度)160179 100109 3级高血压级高血压(重度重度)180 110 单纯收缩期高血压单纯收缩期高血压 140 55 yearsWomen65 yearsSmokingTC5.72mmol/L DiabetesFamily history of premature cardiovascular disease（早发心血管病家族史）早发心血管病家族史）（Men55 years，Women177mol/L）Vascular diseaseVascular diseaseDissecting aneurysmArtery diseaseAdvanced hypertensive Advanced hypertensive retinopathyretinopathyHemorrhage or exudatesPapilledema高血压高血压危险度分层危险度分层 其他危险其他危险因素和病史因素和病史血压血压1级级轻度高血压轻度高血压SBP140-159或或DBP90-992级级中度高血压中度高血压SBP160-179DBP100-1093级级重度高血压重度高血压SBP180DBP110I 无其他危险因素无其他危险因素II 1-2个危险因素个危险因素III 3个危险因素或个危险因素或 TOD或糖尿病或糖尿病IV ACC低危低危中危中危高危高危极高危极高危中危中危中危中危高危高危极高危极高危高危高危极高危极高危极高危极高危极高危极高危Secondary hypertensionSecondary hypertension It is a hypertension of known cause.The importance of identifying patients with SH is that they can sometimes be cured by surgery or by specific medical treatment.Renal parenchymal diseasesRenal parenchymal diseases The most common causes of SH Any diseases of the renal parenchyma(肾实肾实质质):glomerulonephritis(肾小球肾小球肾炎肾炎),diabetic nephropathy(肾病肾病),polycystic kidneys(多囊肾多囊肾).).Most cases are related to increased intravascular volume or increased activity of the RASRenovascular hypertensio