1、 高血压合理用药最新要点讨论及处方分析我国高血压患病率愈来愈高百分比 *(%)0481216201959181410621979 1991 201918.8%全国患病人数已超过 2.0亿中国居民营养与健康现状调查。卫生部、科技部、统计局， 2019、 10、 12我国 18岁及以上居民高血压患病率为 18.8%6.1 8%24.7 30.2 1.6亿18.8 2019年全国营养与健康综合调查（ 18岁）2.9 12.2 26.6 9400万11.26 1991年全国抽样调查 (15岁以上 )控制率服药率知晓率患病人数患病率中国 高血压控制率降压本身的益处平均降低卒中发生率 3540% 心肌梗死
2、 2025% 心力衰竭 50% JNC 7收缩压降低 1012mmHg 或舒张压降低 5-6mmHg1、高血压治疗四大目标 长期、有效、平稳控制血压水平预防 (逆转 )心、脑、肾等靶器官的损害减少心、脑血管疾病的发病和死亡 循证医学改善生活质量亚临床靶器官损害之保护(2009,oct ESH Reappraisal)Evidence on the important prognostic role of subclinical organ damage continues to grow. In both hypertensive patients and the general popula
3、tion, the presence of electrocardiographic and echocardiographic LVH, a carotid plaque or thickening, an increased arterial stiffness, a reduced eGFR (assessed by the MDRD formula), or microalbuminuria or proteinuria substantially increases the total cardiovascular risk, usually moving hypertensive
4、patients into the high absolute risk range.合并亚临床靶器官损害常为高危者： LVH,颈动脉斑块、增厚硬化， eGFR下降，微量 /蛋白尿。-Journal of Hypertension 2009, 27:21212158血压目标 所有患者 140/90 140/90DM/肾病 130/80(DM) 130/80冠心病： 130/80 mm Hg (2019/2009年欧洲高血压指南 )*老年 SBP难于 140可适当灵活些 (尤低危者 )，老年收缩压 可 降至 150 mm Hg以下血压目标 低限？ (ESH June, 2009 )Key amo
5、ng the changes will be the recommendation of a lower threshold level-around 120 mm Hg systolic and 70 mm Hg diastolic-below which it could be dangerous to reduce blood pressure in high-risk individuals, representing the so-called J-curve phenomenon, Mancia said. J-Curve: A Narrow Window of Optimum B
6、P for High-Risk Individuals “J形曲线 ”可能存在，有些特定高危患者血压不宜过低（ 120/70）-June 16, 2009 (Milan, Italy) The European Society of Hypertension (ESH)血压达标 (2009,oct ESH Reappraisal)Each drug class has contraindications as well favorable effects in specific clinical settings. The choice of drug(s) should be made ac
7、cording to this evidence. The traditional ranking of drugs into first, second, third,and subsequent choice, with an average patient as reference, has now little scientific and practical justificationand should be avoided.每种药物均有利弊：应循证选药；强调个性化用药，避免一线、二线、三线-Journal of Hypertension 2009, 27:21212158何时开始
8、用药 (2009,oct ESH Reappraisal)it appears reasonable to recommend that, in grade 1 hypertensives (SBP 140159mmHg or DPB 9099mmHg) at low and moderate risk, drug therapy should be started after asuitable period with lifestyle changes. Prompter initiation of treatment is advisable if grade 1 hypertension is associated with a high level of risk, or if hypertension is grade 2 or 3. 立即用药： a） 2或 3级高血压 ; b） 1级 HT +高危改善生活方式后用药： 1级 HT +低、中危
