会计学高血压与心脏损害高血压与脑血管损害我国高血压患病率愈来愈高6.1％~8%2009中国高血压门诊控制率仅为31.1%合并并发症的患者达标率更低心血管疾病的发生34.5%与高血压相关降压本身的益处美国中国高血压人群的临床特点降低心脑血管事件是降压治疗的根本目的2009中国高血压指南（基层版）要点1、高血压治疗四大目标何时开始用药(2009,octESHReappraisal)itappearsreasonabletorecommendthat,ingrade1hypertensives(SBP140–159mmHgorDPB90–99mmHg)atlowandmoderaterisk,drugtherapyshouldbestartedafterasuitableperiodwithlifestylechanges.Prompterinitiationoftreatmentisadvisableifgrade1hypertensionisassociatedwithahighlevelofrisk,orifhypertensionisgrade2or3.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、中危亚临床靶器官损害之保护(2009,octESHReappraisal)Evidenceontheimportantprognosticroleofsubclinicalorgandamagecontinuestogrow.Inbothhypertensivepatientsandthegeneralpopulation,thepresenceofelectrocardiographicandechocardiographicLVH,acarotidplaqueorthickening,anincreasedarterialstiffness,areducedeGFR(assessedbytheMDRDformula),ormicroalbuminuriaorproteinuriasubstantiallyincreasesthetotalcardiovascularrisk,usuallymovinghypertensivepatientsintothehighabsoluteriskrange.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。----JournalofHypertension2009,27:2121–2158血压目标所有患者<140/90<140/90DM/肾病<130/80(DM)<130/80冠心病：130/80mmHg(2007/2009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150mmHg以下血压目标——低限？(ESHJune,2009)Keyamongthechangeswillbetherecommendationofalowerthresholdlevel--around120mmHgsystolicand70mmHgdiastolic--belowwhichitcouldbedangeroustoreducebloodpressureinhigh-riskindividuals,representingtheso-calledJ-curvephenomenon,Manciasaid.J-Curve:ANarrowWindowofOptimumBPforHigh-RiskIndividuals“J形曲线”可能存在，有些特定高危患者血压不宜过低（<120/70）----June16,2009(Milan,Italy)—TheEuropeanSocietyofHypertension(ESH)2、治疗策略（中国）几周内渐降血压至目标,更长/更短期间？（几天？）推荐长效剂，持续24小时、T/P>50%，Qd，提高顺从、平稳降压据血压水平、RF、TOD、ACC,选单或多药联合制定个性化方案：2级以上高血压常需联合用药，配合非药物疗法达标快慢：(2009,JuneESH)"In2007,wetookastrongstanceinfavorofcombinationtreatment.Thishasbeenshownagain--trialssuchasACCOMPLISH,ADVANCE,HYVET,ASCOTandONTARGETarechangingthepicture.WehavetolowerBPratherquickly[inthesepatients]totrytopreventacatastrophe,"