高血压的预防与控制.ppt
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1、高血壓的預防與控制,高血壓程度上之分類,18歲以上之成人收縮壓及舒張壓 血壓分類 收縮壓 舒張壓 理想血壓 160 100 獨立收縮性高血壓 140-149 90 張孟源內科診所,高血壓的診斷 實驗檢查:,心電圖 尿液檢查 血液檢查 生化檢查 胸部 x 光檢查 張孟源內科診所,Ambulatory BP monitor,ABPM is warranted for evaluation of white coat hypertension ABPM values usually lower than clinics reading Awake have an average 135/85 and
2、 during sleep 120/75 BP drop 10 to 20% at night if not signs possible increase risk of CVD 張孟源內科診所,斜塔,JNC7的新遠景和新資訊,任何一個50歲以上的個人其收縮壓的控制比舒張壓更為重要 在55歲時為正常血壓的人其一生中有90%的機率產生高血壓。 張孟源內科診所,心血管疾病的盛行率,CVD account for 30% of death world wild CVD leading cause of deaths in developed countries By 2020 CVD will b
3、ecome #1 killer in developed Countries/economies in transition 張孟源內科診所,心血管疾病的盛行率 36 out of 100 people will die of CVD in 2020,Cause 1990 1999 2020 million(%) million(%) million(%) 冠狀動脈疾病 6.2 (12.4%) 7.1(12.7%) 11.1(16.2%) 腦中風 4.3(8.5%) 5.5(9.9%) 7.7 (11.3%) 其他血管疾病 2.6(5.1%) 4.3 (7.7%) 6.0 (8.8%) 所有血
4、管疾病 13.1(26%) 16.9(30.3%) 24.8(36.3%) WHO 張孟源內科診所,Causes of Hypertension,Essential hypertension Chronic renal disease, renovascular dx Primary hyperaldosteronism Pheochromocytoma ,cushing syndrome Sleep apnea Drug induced and chronic steroid user Thyroid or parathyroid disease 張孟源內科診所,代謝性症候群:大流行的反擊,
5、.,全球現代化的改變,糖尿病和CVD 危險因子,糖尿病 高血壓,高罹患率與死亡率,高社經地位,代謝性症候群: 遺傳因子與環境的交互作用,.,環境因素,Early Life Adult Life 出生你體重不足 做是生活型態 營養不足 飲食因素,代謝性症候群,心血管疾病,基因,高血壓是否屬於代謝性症候群?,造成高血壓因素: 肥胖 胰島素抗性 遺傳 老化 飲食因素 高血壓是否為一代謝性危險份子? 高血壓前期是否亦計算成危險份子?,中央肥胖與代謝異常,中央肥胖與代謝異常,動脈硬化 血脂異常,胰島素抗性,血栓栓塞,發炎反應,Primary prevention,1 Primary prevention
6、 of HTN may improve quality of life and costs associated with medical management and its complication 2.In those higher than optimal120/80mmHg decrease 3 mmHg decrease 8% stroke 5% CVD risk 3.Individuals at highest risk should be strongly encouraged to adapt healthy life 張孟源內科診所,Pre-hypertension sta
7、ge,Pre-hypertension signals the need for Increase education to reduce BP in order to prevent hypertension Pre-hypertension are at increased risk for Progression to hypertension at double risk 張孟源內科診所,JNC7的新遠景和新資訊,即使收縮壓在120-139之間舒張壓在80-89之間,仍是為高血壓前期,必須改善健康的生活型態,以避免高血壓的產生。 自從115/75mmHg以上每增加20/10mmHg心血
8、管得危險性倍增。 張孟源內科診所,Benefits of Lowering BP,Average percent reduction Stroke incidence 35-40% Myocardial infarction 20-25% Heart failure 50% 張孟源內科診所,Benefits of Lowering BP,In stage I hypertension and additional CVD Risk factors, achieving a sustained 12mmHg Reduction in SBP over 10 yrs will prevent 1
9、death for 11 patients Each increment of 20/10mmHg double the Risk of CVD across the entire BP range Starting from 115/75 張孟源內科診所,高血壓治療原則,血壓必須控制在理想範圍 SBP 140mmHg ,DBP 90mmHg 血壓必須長期控制 張孟源內科診所,Treatment of hypertension in adult with DM,SBP DBP Goal 130 mmHg 80 mmHg 張孟源內科診所,Goal of Therapy,Reduce CVD an
10、d renal morbidity and mortality Treatment of BP 50 years of age 張孟源內科診所,高血壓控制比率,全國健康評估報告美 1976-1986 1988-1991 1991-1994 1999-2000 Awareness 51 73 68 70 Treatment 31 55 54 59 Control 10 29 27 34 張孟源內科診所,JNC7的新遠景和新資訊,最有效的治療方式,必須由主動積極的高血壓患者,與具有專業及愛心的醫師互相配合。 醫病關係是建立在,同理心,互相協商 彼此了解。 正向的互動,與良好醫病關係,奠定治療 成功
11、的基礎。 張孟源內科診所,Follow-up and Monitor,Patient should returned for follow-up and adjustment of medications until BP goal is reached More frequent visits for stage II HTN and complicated comorbid condition Serum potassium and creatinine monitor 張孟源內科診所,Hypertension in older person,More than two-third of
12、people with 65 with HTN This population has the lowest rate of BP control Treatment including isolated systolic HTN Lower initial drug dose and then standard dose will be needed to reach BP target 張孟源內科診所,Hypertension in Women,Oral contraceptives may increase BP and BP should check regularly ,in con
13、trast HRT Dose not raise BP Pregnant women with HTN should be Followed carefully ,BB and vasodilator 張孟源內科診所,Left ventricular hypertrophy,LVH is an independent risk factor that increases the risk of CVD Regression of LVH with aggressive BP Measurement and weight loss, exercise sodium restriction and
14、 medication control 張孟源內科診所,Peripheral Arterial Disease,PAD is equivalence in risk to ischemic Heart disease Other risk factor should be managed aggressively ,aspirin should be used. 張孟源內科診所,Dementia,Dementia and cognitive impairment occurred more commonly in people with hypertension Reduced progres
15、sion of cognitive impairment occurs with effective antihypertensive therapy 張孟源內科診所,Target Organ Damage,Heart : LVH ,angina .coronary revascularization, heart failure Brain : stroke ,transient ischemic attack Chronic kidney disease Peripheral vascular disease Retinopathy 張孟源內科診所,Hypertensive urgenci
16、es and emergencies,Patients with marked BP elevations and acute TOD ( encephalopathy ,myocardial infarction unstable angina ,pulmonary edema, eclampsia .stroke ,head trauma Aortic dissection required hospitalization 張孟源內科診所,Hypertensive urgencies and emergencies,Patient with marked elevated BP witho
17、ut TOD should immediately antihypertensive drug. 張孟源內科診所,Postural hypotension,Decrease in standing SBP 10mmHg associated with dizziness /fainting ,more frequent in older SBP BP in these individuals should be monitor in upright position Avoiding volume depletion and excessive rapid dose titration of
18、drug 張孟源內科診所,代謝性症候群成因 ATPIII觀點,.,肥胖,體能活動不足,基因感受性,動脈粥樣硬化 血脂異常,血壓升高,胰島素抗性,臨床前期 血栓狀態,臨床前期 發炎狀態,高血壓飲食原則1,採行DASH飲食:即富含穀類、水果、蔬菜和低脂乳製品的飲食計畫,以攝取鈣、鉀和鎂。 1.每日攝取7-8份五穀類 2.每日攝取8-10份蔬菜水果 3.每日攝取2-3份乳製品 4.每日攝取4-5份堅果類、種子類或豆類 5.每日應攝取低於2份或更少的動物性蛋白質 張孟源內科診所,高血壓飲食原則2,低鈉飲食 1.選擇新鮮食物並自己做,減少攝取外食時所含量較高的味精和食鹽 2.燉湯及濃湯、火鍋湯有較高鹽分
19、,少飲用 3.含鹽量高的食物宜注意食用。如:海帶、芹菜。 4.低鈉鹽和低鈉醬油有大量的鉀,腎病患者不宜使用 張孟源內科診所,健康的飲食,Weight reduction program, total calories intake Healthy diet: low salt, low fat and low cholesterol , and high fiber diet Balance diet and heath food with adequate mineral and vitamin supple 張孟源內科診所,運動的重要性,脂肪能源對生存的重要性 第二型糖尿病和腹腰部肥胖具高
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