![中国高血压防治指南 - file.medtrib.cn · 控制率较高[7-8];不同民族比较,少数民族居民的高血压治疗 率和控制率低于汉族[1,9]。 1.3 我国人群高血压发病重要危险因素](https://static.fdocuments.net/doc/165x107/5f222ad9b6a087744a7749a9/eeeoe-file-cefe7-8oeefceec.jpg)
中国高血压防治指南 - file.medtrib.cn · 控制率较高[7-8];不同民族比较,少数民族居民的高血压治疗 率和控制率低于汉族[1,9]。 1.3 我国人群高血压发病重要危险因素
高血压与降压治疗策略 中国高血压防治指南解读
43
高高高高高高高高高高 高高高高高高高高高高高
description
高血压与降压治疗策略 中国高血压防治指南解读. 中国高血压防治指南 (2005) 血压水平分类和定义. 分类 收缩压 (mmHg) 舒张压 (mmHg) 正常血压 < 120 和 < 80 正常高值 120-139 或 80-89 高血压 140 或 90 1 级 140-159 或 90-99 - PowerPoint PPT Presentation
Transcript of 高血压与降压治疗策略 中国高血压防治指南解读
高血压与降压治疗策略中国高血压防治指南解读
中国高血压防治指南 (2005)血压水平分类和定义
分类 收缩压 (mmHg) 舒张压 (mmHg)
正常血压 < 120 和 < 80正常高值 120-139 或 80-89
高血压 140 或 90 1 级 140-159 或 90-99 2 级 160-179 或 100-109 3 级 180 或 110
单纯收缩期高血压 140 和 < 90
男性女性合计
60
45
30
15
0
构成
比例
(%
)
正常血压 正常高值 高血压 I 级 高血压 II 级 高血压 III 级
36.1
48.4
43.0
38.6
34.0
30.4
15.612.3
13.7
5.8 5.1 5.42.5 2.4 2.4
中国大陆成年人群血压水平分类 (2002)
卫生部心血管病防治研究中心，中国心血管病报告 2007
中国大陆人群血压正常高值检出率 (%)1991(29.0%) ～ 2002(34.0%)
18-24 25.4 28.5
25-34 26.0 30.9
35-44 30.2 36.7
45-54 32.9 38.0
55-64 32.7 34.9
65-74 31.2 30.3
75~ 28.7 28.1
年龄组 1991 年 2002 年
卫生部心血管病防治研究中心，中国心血管病报告 2007
Prospective Studies Collaboration. Lancet. 2002;360:1903-1913.
StrokeStrokeStrokeStroke CHDCHDCHDCHD
256256
128128
6464
3232
1616
88
44
22
11
120120 140140 160160 180180Usual SBP (mmHg)Usual SBP (mmHg)
Stro
ke m
orta
lity
Stro
ke m
orta
lity
(flo
atin
g ab
solu
te r
isk
and
95%
CI)
(flo
atin
g ab
solu
te r
isk
and
95%
CI)
Age Age at riskat risk
(y):(y):
80-8980-89
70-7970-79
60-6960-69
50-5950-59
80-8980-89
70-7970-79
60-6960-69
50-5950-59
Age Age at riskat risk
(y):(y):
256256
128128
6464
3232
1616
88
44
22
11
120120 140140 160160 180180Usual SBP (mmHg)Usual SBP (mmHg)
•• •• •• •••• •• •• ••
••
••••••••
••••••••
••
••
••
••
••
••••
•••• ••
••••
••
••••
••
••••
••
••
•• ••
••
40-4940-49
••
••••
••
••
••
••
••
••
••
••
••
••
••••
•• •• •• •• •• •• •• ••
••••••
••••••••••
•• •• •••• ••
••••
••••
•• •• •• •• •• ••
••••
Stroke and CHD Mortality Rate in Each Decade of Age versus Stroke and CHD Mortality Rate in Each Decade of Age versus Usual Systolic Blood Pressure at the Start of That DecadeUsual Systolic Blood Pressure at the Start of That Decade
100%
80%
60%
40%
20%
0%<40 40-49 50-59 60-69 70-79 80+
17% 16% 16% 20% 20% 11%
Age (y)
Fre
qu
ency
of
hyp
erte
nsi
on
sub
typ
es in
all
un
trea
ted
sub
ject
s (%
)
Frequency distribution of untreated hypertensive individuals by age and hypertension subtype. Numbers at the tops of bars represent the overall percentage distribution of untreated hypertension in that age group. ■, ISH (SBP≥140 mm Hg and DBP<90 mm Hg); ■, SDH (SBP≥140 mm Hg and DBP≥90 mm Hg); ■, IDH (SBP<140 mm Hg and DBP≥90 mm Hg).
IDH, SDH and ISH Subtypes in American Patients
Franklin SS. Hypertension 2001;37:869
Huang J, et al. J Hypertens 2004;17:955-962
IDH, SDH and ISH Subtypes in Chinese Patients
中国高血压防治指南 (2005)心血管危险水平分层
血压 (mmHg)
1 级 2 级 3 级SBP 140~159 或 SBP 160~179 或 SBP≥180或
DBP 90~99 DBP 100~109 DBP≥110
I 无其它危险因素 低危 中危 高危
II 1~2 个危险因素 中危 中危 很高危
III ≥3 个危险因素 高危 高危 很高危或靶器官损害或糖尿病
IV 并存临床情况 很高危 很高危 很高危
其它危险因素和病史
Microalbuminuria
6
5
4
3
2
1
0
Rel
ati
ve
risk
of
IHD
SBP < 140 SBP 140-160 SBP >160
Normoalbuminuria
2.5 (1.2-5.3)
5.3 (2.2-13.0)
3.3 (1.6-6.9)
2.2 (1.3-3.7)
1.01.5 (0.9-2.7)
收缩压、微量蛋白尿与心血管危险
Borch-Johnsen K, et al. Arteioscler Thromb Vasc Biol 1999; 19:1992
HOT ：心血管危险分层与 CVD 事件
BMJ 2002, 324:71
RR ： 1.58 1.38 1.60 1.79 1.51Cl: 1.45-1.72 1.18-1.61 1.41-1.82 1.56-2.05 1.38-1.66P: <0.0001 <0.0001 <0.0001 <0.0001 <0.0001
Majorcardiovascular
events
All myocardialinfarction
All stroke Cardiovascularmortality
Totalmortality
Risk:
Medium
High
Very High
20
15
10
5
0
Eve
nts
per
10
00 p
atie
nt
year
s
中国高血压防治疗指南中国高血压防治疗指南 (2010)(2010)心血管高危患者建议
• 收缩压≥ 180mmHg 和 / 或 舒张压≥ 110mmHg
• 糖尿病• ≥3 个心血管危险因素• 伴 1 个或多个亚临床器官损害 :
– 心电图 ( 尤其是心肌劳损 ) 或超声心动图 ( 尤其是向心性 ) 左心室肥厚– 超声检查显示颈动脉壁增厚或斑块– 动脉硬度增加– 血清肌酐轻度升高– 估测的肾小球滤过率或肌酐清除率下降– 微量白蛋白尿或蛋白尿
• 临床心、脑血管病或慢性肾脏疾病
★★★
中国高血压防治指南 (2005)降压治疗的实施过程
对高血压患者临床评价后，进行心血管危险水平分层 ( 低危、中危、高危、很高危 )
所有患者都应采用非药物治疗措施
制定降压治疗计划，确定血压控制目标值 很高危、高危患者：立即开始药物治疗 中危：随访观测数周，然后决定是否开始药物治疗 低危：随访观测数月，然后决定是否开始药物治疗
治疗随访，调整治疗方案
CHD events StrokesNo of No of Relative risk relative risk No of No of Relative risk Relative risk
Blood pressure difference trials trials events (95% CI) (95% CI) trials events (95% CI) (95% CI)
No history of vascular disease 26 3429 0.79 (0.72 to 0.86) 25 2843 0.54 (0.45 to 0.65)
History of coronary heart disease 37 5815 0.76 (0.68 to 0.86) 12 984 0.65 (0.53 to 0.80)
History of stroke 13 567 0.79 (0.62 to 1.00) 13 1593 0.66 (0.56 to 0.79)
All trials 71 9811 0.78 (0.73 to 0.83) 45 5420 0.59 (0.52 to 0.67)
Cohort studies 61 10450 0.75 (0.73 to 0.77) 61 2939 0.64 (0.62 to 0.66)
0.5 0.7 1 1.4 20.5 0.7 1 1.4 2 0.5 0.7 1 1.4 2
Treatmentbetter
Placebobetter
Placebobetter
Treatmentbetter
Relative risk estimates of CHD events and stroke in clinical trials and in epidemiological cohort studies
Meta-analysis of 147 randomised trials
Law MR, et al. Online from BMJ.com on 24 May, 2009
For reduction of 10mmHg SBP and/or 5mmHg DBP
在中国大陆的降压治疗临床试验
STONE ↓57% ↓41%
CNIT ↓50% ↓44%
Syst-China ↓38% ↓37%
FEVER ↓28% ↓28%
Stroke CVD
10
8
6
4
2
0
-2
-40 5 10 15 30
Absolute risk of CHD event(per 1000 patients of follow-up)
CH
D e
ven
ts s
aved
(per
100
0pat
ien
t-ye
ars
of
trea
tmen
t)
STOP-1
EUROPAPROGESS
TEST
PATS
Coope & Warrender
Syst-Eur
Syst-China
SHEP EWPHE
Dutch TIA
MRC-1
HOPE
IDNT
SCOPE
HDFP
20 40
ANBP-1
DIABHYCARMRC-E
QUIETPEACE
PART2RENAAL
25 35
心血管危险程度与降压治疗绝对获益CHD Events
14
12
10
8
6
4
2
00 10 20 30 40 50 60 70
Absolute risk of stroke(per 1000 patients of follow-up)
Str
oke
s sa
ved
(per
100
0pat
ien
t-ye
ars
of
trea
tmen
t)STOP-1
PATS
PROGESS
HSCSG
STONE
Coope & Warrender
Syst-EUR
Syst-ChinaSHEP
EWPHE
MRC-E
MRC-1
HDFP
心血管危险程度与降压治疗绝对获益STROKE
0.5 1.0 2.0
Relative Risk RR (95% CI)RR (95% CI)BP DifferenceBP Difference
(mm Hg)(mm Hg)
FavorsFavorsFirst ListedFirst Listed
FavorsFavorsSecond ListedSecond Listed
Major CV eventsMajor CV events
CV mortalityCV mortality
Total mortalityTotal mortality
1.02 (0.98, 1.07)1.02 (0.98, 1.07)2/02/0 ACEI vs D/BBACEI vs D/BB
1.03 (0.95, 1.11)1.03 (0.95, 1.11)2/02/0 ACEI vs D/BBACEI vs D/BB
1.00 (0.95, 1.05)1.00 (0.95, 1.05)2/02/0 ACEI vs D/BBACEI vs D/BB
1.04 (0.99, 1.08)1.04 (0.99, 1.08)1/01/0 CA vs D/BBCA vs D/BB
1.05 (0.97, 1.13)1.05 (0.97, 1.13)1/01/0 CA vs D/BBCA vs D/BB
0.99 (0.95, 1.04)0.99 (0.95, 1.04)1/01/0 CA vs D/BBCA vs D/BB
0.97 (0.92, 1.03)0.97 (0.92, 1.03)1/11/1 ACEI vs CAACEI vs CA
1.03 (0.94, 1.13)1.03 (0.94, 1.13)1/11/1 ACEI vs CAACEI vs CA
1.04 (0.98, 1.10)1.04 (0.98, 1.10)1/11/1 ACEI vs CAACEI vs CA
Blood Pressure Lowering Treatment Trialists’ Collaboration. Blood Pressure Lowering Treatment Trialists’ Collaboration. LancetLancet. 2003;362:1527-1535.. 2003;362:1527-1535.
BP-Lowering Treatment TrialistsComparisons of Different Active Treatments
BPLTT: STROKEComparisons of different active treatments
2003
RR (95% CI) Favours first listed
Favours second listed
0.5 1.0 2.0Relative Risk
BP difference(mm Hg)
1.09 (1.00,1.18) ACEI vs. D/BB
0.93 (0.86,1.01) CA vs. D/BB
1.12 (1.01,1.25) ACEI vs. CA
2/0
1/0
1/1
0.5 0.7 1 1.4 2
Specified Drug better
0.5 0.7 1 1.4 2
Placebobetter
Specified Drug better
Placebobetter
Coronary heart disease events Stroke
No of No of Relative risk relative risk No of No of Relative risk Relative risk
trials events (95% CI) (95% CI) trials events (95% CI) (95% CI)
Thiazides 11 1710 0.86 (0.75 to 0.98) 10 1370 0.62 (0.53 to 0.72)
blockers 6 851 0.89 (0.78 to 1.02) 7 690 0.83 (0.70 to 0.99)
Anglotensin converting enzyme inhibitors 21 4083 0.83 (0.78 to 0.89) 13 1220 0.78 (0.66 to 0.92)
Angiotensin receptor blockers 4 378 0.86 (0.53 to 1.40) 0 0
Calcium channel blockers 22 2009 0.85 (0..78 to 0.92) 9 976 0.66 (0.58 to 0.75)
Drug choice open 5 871 0.89 (0.78 to 1.01) 4 763 0.96 (0.75 to 1.23)
All classes of drug 64 9417 0.85 (0.81 to 0.89) 38 4712 0.73 (0.66 to 0.80)
Relative risk estimates of CHD events and stroke according to class of drug
Law MR, et al. Online from BMJ.com on 24 May, 2009
Excluding CHD events in trials of β blockers in people with a history of CHD
SBP difference between randomized groups (mmHg)SBP difference between randomized groups (mmHg)
Relative risk of outcome eventRelative risk of outcome event
1.501.50
1.251.25
1.001.00
0.750.75
0.500.50
0.250.25
1.501.50
1.251.25
1.001.00
0.750.75
0.500.50
0.250.25
1.501.50
1.251.25
1.001.00
0.750.75
0.500.50
0.250.25
1.501.50
1.251.25
1.001.00
0.750.75
0.500.50
0.250.25
1.501.50
1.251.25
1.001.00
0.750.75
0.500.50
0.250.25
StrokeStroke Major CVDMajor CVD CHDCHD
CVD deathCVD death Total mortalityTotal mortality
-10-10 -8-8 -6-6 -4-4 -2-2 00 22 44 -10-10 -8-8 -6-6 -4-4 -2-2 00 22 44 -10-10 -8-8 -6-6 -4-4 -2-2 00 22 44
-10-10 -8-8 -6-6 -4-4 -2-2 00 22 44 -10-10 -8-8 -6-6 -4-4 -2-2 00 22 44
Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet. 2003;362:1527-1535.
BPLTTC (WHO/ISH, 2003)
中国高血压防治指南 (2005)血压控制目标值
中青年高血压患者 <140/90 mmHg
老年高血压患者 <150/90 mmHg
糖尿病或肾病患者 <130/80 mmHg
INVEST血压控制达标与终点事件发生的关系
15.0
5.7
2.4
10.8
4.3
2.3
9.2
3.8
1.6
8.1
3.1
1.1
16
14
12
10
8
6
4
2
0<25% ≥25% 至 <50% ≥50% 至 <75% ≥75%
随诊时血压达标百分比（ 140/90 mmHg ）患者总数（ n ） 3838 3757 6664 8316
一级终点心肌梗死（致死＋非致死性）脑卒中（致死＋非致死性）
发生临床终点事件百分
比 P 值均小于 0.001
VALUE ： BP Control and OutcomesClinical outcomes by proportion of time with BP ControlClinical outcomes by proportion of time with BP Control
(covariate adjusted)(covariate adjusted)
proportion of time with BP HR (95% CI) Reduced Risk Increased RiskControl (< 140; 90mmHg)Primary Endpoint < 25% 1.79 (1.357-2.363)≥ 25% to < 50% 1.30 (1.035-1.625)≥ 50% to < 75% 1.06 (0.875-1.277)≥ 75% 1.00CV morbidity or Mortality < 25% 1.76 (1.382-2.243)≥ 25% to < 50% 1.24 (1.009-1.513)≥ 50% to < 75% 1.14 (0.893-1.250)≥ 75% 1.00MI (Fatal and non fatal)< 25% 1.64 (1.073-2.509)≥ 25% to < 50% 1.24 (0.079-1.757)≥ 50% to < 75% 1.14 (0.859-1.512)≥ 75% 1.00Stroke (Fatal and non fatal)< 25% 2.04 (1.270-3.265)≥ 25% to < 50% 1.14 (0.761-1.697)≥ 50% to < 75% 1.11 (0.822-1.535)≥ 75% 1.00Hospitalization for CHF< 25% 1.74 (1.157-2.630)≥ 25% to < 50% 1.16 (0.831-1.630)≥ 50% to < 75% 0.99 (0.746-1.314)≥ 75% 1.00
0 0.5 1.5 2.5 3.5321HR (95% CL)
Exponential time-to-event model adjusted for covariates age. BMI history of CHD. Stroke. LVH. Type 2 diabetes. Smoking.High total cholesterol and proteinuria. Additional adjustment for 5th order polynomials of msDBP and msSBP.
Major cardiovascular events (per 100 patients-years) in all treated hypertensive and in hypertensive patients with diabetes in relation to target blood pressures of 90. 85, and 80 mm Hg.
30
25
20
15
10
5
0 80 85 90 90 85 80
P=0.50 for trend
P=0.005 for trend
All hypertensive patients(n=18790)
Hypertensive with diabetes(n=1501)
Target blood pressure groups
Maj
or
card
iov
ascu
lar
even
ts/
100
0 p
atie
nts
-yea
rs
HOT: 糖尿病患者血压控制与 CV 事件发生率
10
9
8
7
6
5
4
100 110 120 130 140 150 160 170
Achieved systolic blood pressure (mmHg)
An
nu
al p
atie
nt
even
t ra
te (
%)
Median systolic bloodPressure (mmHg) 106 116 125 135 144 154 168
No. of person-Years 1431 4266 8974 11983 9138 4942 3470
ADVANCE: Achieved BP levels and all renal events
De Galan BE, et al. J Am Soc Nephrol. 2009; Feb.18, online
SBPs achieved by treatment in placebo-controlled trials in elderly hypertensives
EWPHE 840 72 182 150 172 Coope and Warrender 884 68 196 162 180 SHEP 4376 72 170 143 155 STOP-1 1627 76 195 167 186 MRC elderly 4396 70 185 156 165 Syst-Eur 4695 70 174 151 161 Syst-China 2394 67 171 151 160SCOPE 4964 76 166 145 148 HYVET 3845 83 173 144 159JATOS 4418 74 171 138 147
Zanchetti A, et al. J Hypertens. 2009;27:
N Age(years) Baseline SBPAchieved SBP
Active Control
中国高血压防治指南 (2005)长期治疗随访实施过程
继续治疗
血压控制 1 年以上可减少剂量
治疗 3 个月后，达到降压目标值
治疗 3 个月后，未达到降压目标值 有明显副作用
增加剂量
改用另一类降压药
联合治疗
改用另一类降压药
减少剂量
◆ 降压治疗后血压下降幅度主要取决于：
血压水平和药物平均剂量
SBP↓= 9.1+0.1(P-154)
DBP↓= 5.5+0.11(P-97)
Law MR, et al. BMJ. 2003;326:1427-1431.
降压药物联合治疗的依据 ( 一 )
◆ 150/90 时，一种药物在标准剂量下，血压平均
降低仅 8.7/4.7 mmHg ；一种、两种、三种药物
在 1/2 标准剂量下，血压分别平均降低 6.7/3.7 、
13.3/7.3 、 19.9/10.7 mmHg 。
Law MR, et al. BMJ. 2003;326:1427-1431.
SBP↓= R+n×0.078 (P-150)
DBP↓= R+n×0.088 (P-90)
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0Thiazide Beta blocker ACE Inhibitor Calcium channel
blockerAll Classes
1.04(0.88-1.20)
1.00(0.76-1.24)
1.16(0.93-1.39)
1.01(0.90-1.12)
Adding a drug from another class(on average standard doses)
Doubling dose of same drug(from standard dose to twice standard)
Inc
rem
en
tal
sy
sto
lic
blo
od
pre
ss
ure
re
du
cti
on
Ra
tio
of
ob
se
rve
d t
o e
xp
ec
ted
ad
dit
ive
eff
ec
ts
0.89(0.69-1.09)
0.19(0.08-0.30)
0.23(0.12-0.34) 0.2
(0.14-0.28)
0.37(0.29-0.45)
0.22(0.19-0.25)
降压药物联合治疗的依据 ( 二 )Combination Therapy Versus Monotherapy
Meta-analysis from 42 trials
Wald DS, et al. Am J Med. 2009;122:290-300.
• 通过不同的药理作用，中和或对抗相互的不良反应。
• 通过降低剂量减少和减轻不良反应。
降压药物联合治疗的依据 ( 三 )
不良反应 (A+B) < 不良反应 (A) + 不良反应 (B)
不良反应 (A+B) < 不良反应 (2A) 或 < 不良反应 (2B)
优化降压联合治疗方案
DHP-CCB + ACEI/ARB ★★★ (ASCOT, ACCOMPLISH)
DHP-CCB + βblocker ★★ (HOT, INSIGHT, ALLHAT)
ACEI/ARB + Diuretics ★★ (LIFE, VALUE, ACCOMPLISH)
DHP-CCB + Diuretics ★★ (VALUE, FEVER)
ACEI/ARB + β blocker ★ (ALLHAT)
β blocker + Diuretics ★ (LIFE, ASCOT, INSIGHT)
ACEI + ARB ─ (ONTARGET)
INSIGHT ：糖尿病患者终点事件患
者百
分数
(%)
0.0
4.0
8.0
Co-amilozide
12.0
p = 0.03
14.214.2
Nifedipine GITS
16.0
20.0
18.718.7
Mancia G, et al. Hypertension 2003;41:431–6.
所有主要终点 , 非心脑血管性死亡 ,ESRD, 心绞痛和短暂性脑缺血
Co-amilozideNifedipine GITS
INSIGHT serious and metabolic adverse events
Serious adverse events
0% 5% 10% 15% 20% 25% 30%
0% 2% 4% 6% 8% 10%
Nifedipine GITS
Co-amilozide
Hypokalaemia
p=0.02
p<0.0001
Hyponatraemia
Hyperlipidaemia
Hyperglycaemia
Impaired renal function
Hyperuricaemia
p<0.0001
p<0.0001
p=0.001
p<0.0001
p<0.0001
Brown M, et al. Lancet 2000;356:366–72.
176 (5.6%)
INSIGHT: 对新发糖尿病的影响
Nifedipine GITS0
20
40
60
80
100
120
140
160
180
Co-amilozide
136 (4.3%)
p=0.023
Pat
ien
ts w
ith
new
ly d
iag
no
sed
d
iab
etes
mel
litu
s (n
)
Mancia G, et al. Hypertension 2003;41:431–6.
（氨氯地平 +/- 培哚普利 Vs. 阿替洛尔 +/- 苄氟噻嗪）
*P<0.05
降低百分比(%)
-35
-30
-25
-20
-15
-10
-5
0
* *
*
*
*
**
非致死心梗和冠心病死亡
心血管死亡 总死亡 总冠脉事件
致死 /非致死性
卒中
总心血管事件和
介入新发
糖尿病肾损害
Dahlof B, Sever P, et al. Lancet. 2005;366:895-906.
ASCOT-BPLA: 终点事件发生率
Cum
ulat
ive
even
t ra
te
HR (95% CI)
0.80 (0.72, 0.90)
20% Risk Reduction
Time to 1st CV morbidity/mortality (days)
p = 0
ACEI / HCTZ
CCB / ACEI650
526
.0 002
ACCOMPLISH: 主要终点
中国高血压人群的临床特点
最主要的心血管危险是脑卒中
高血压发生和血压水平与摄盐量或饮食钠 / 钾比值较高密切有关
老年人占的比例很高
约定 1/10 男性患者有嗜酒行为
脑卒中与心肌梗死的比值不同临床试验比较
STONE 8.0
Syst-China 8.7
NICS-EH 4.0
SHEP 1.2
MRC II 0.8
STOP-H 1.2
Syst-Eur 1.7
ACTION: Events in Patients with Hypertension vs ISH
Primary Endpoint – Efficacy
Primary Endpoint – safety
Any CV Event
Death, any CV Event orRevascularisation
Any Vascular Event orRevascularisation
0.65 1 1.3HR (95% CI)
Elliott & Meredith, 2009
Favours Nifedipine GITSFavours Nifedipine GITS Favours PlaceboFavours Placebo
All patients
Hypertensives
ISH patients
Initial therapy with a low dose DHP-CCB or DHP-CCB/RAS blocker or DHP-CCB/β-blocker combination
Continue withcurrent therapy
Up-titration ofcombination therapysuccessively to the
highest dose
DHP-CCB/RAS blocker/diuretic or DHP-CCB/β-blocker/diuretic combination
and up-titration
Continue withCurrent therapyContinue with
current therapy
Add an -blocker,Or spironolactone
Continue withcurrent therapy
IS BLOOD PRESSURE CONTROLLED ?IS BLOOD PRESSURE CONTROLLED ?
Yes No
NoYes
Yes No
降压治疗方案推荐流程
New recommendation
Reinforcement of previous recommendation
Different interpretations of results/potential for confusing messages to clinical practice
欧洲高血压治疗指南修改背景(ESC/ESH,2009)
欧洲高血压治疗指南修改要点(ESC/ESH,2009)
◆ 重申心血管危险分层
◆ 推荐 80 岁以上高龄高血压患者实施降压治疗
◆ 解释启动降压治疗血压水平和血压控制目标
一般人群：≥ 140/90 ， <140/90
高危以上人群： < 130/85 ， <130/80
◆ 建议在心血管高危患者血压控制不低于 120/70 。
◆ 淡化一线降压药物概念，强调首选联合治疗，
重视 ACEI 、 ARB 和 CCB 的治疗地位。
