JNC8_最新高血压管理与联合降压治疗.ppt
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1、2013 ACC/AHA Guideline 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults & 单片复方制剂(SPC) 降压治疗,2010版中国高血压防治指南,2012KDIGO:CKD血压管理指南,2012加拿大指南,JNC8 ESH高血压指南,优化血压管理:各国指南推陈出新,2011NICE高血压指南,2013ADA糖尿病指南,ESC欧洲高血压指南,2009ESC指南再评价,JNC8,NHLBI的未完之作,JNC时代的休止符,JNC 1: published 1977 JN
2、C 2: published 1980 JNC 3: published 1984 JNC 4: published 1988 JNC 5: published 1992 JNC 6: published 1997 JNC 7: published 2003,美国国家高血压教育(NHBPEP)计划工作组 美国国立心、肺、血液病研究所(NHLBI) 共同推出一份建议,以划定高血压人群、明确可在降压治疗中获益的患者,并给出合理的治疗药物,1973 推出 “Data base for Effective Antihypertensive therapy”,开始执行NHBPEP,JNC8: publi
3、shed 2013,编写 国家 高血压 指南,JNC8工作组,NHLBI放弃指南编写,与AHA合作,由AHA主导编写2014美国高血压指南,NHLBI离去后的JNC8工作组,聚焦2013高血压领域:指南更新,透过指南的更新,可以看出进行高血压管理是趋势及精髓!,美国预防、检测、评估和治疗高血压委员会(JNC) 第8次报告也曾被业界称为“JNC Late”,JNC 8 内容概览,指南重点突出:循证为依托,RCT研究证据为导向,推荐具有循证证据的降压治疗方案 JNC8 全文共14页,引用45篇文献,就高血压治疗的3个最重要的问题,进行了相应的回答,并强调了3大策略,列出9条推荐 4大一线治疗方案:
4、利尿剂/ CCB/ACEI/ARB,未推荐BB 对心衰预后的改善是起始治疗选药的重要考虑之一,http:/ 3个问题,JNC 8 三个问题,http:/ 降压药物治疗至特定的目标血压能否改善健康状况? 不同的降压药物或药物种类对特定健康状况的利弊相对如何?,总结 JNC8 9条推荐,JNC8 推荐 1,对60岁的高血压患者,收缩压(SBP)150 mm Hg或舒张压(DBP) 90 mm Hg即需启动降压药物治疗,目标血压150/90 mm Hg (A级推荐);,In the general population aged 60 years or older, initiate pharmac
5、ologic treatment to lower BP at systolic blood pressure (SBP) of 150 mm Hg or higher or diastolic blood pressure (DBP) of 90 mm Hg or higher and treat to a goal SBP lower than 150 mm Hg and goal DBP lower than 90 mm Hg. Strong Recommendation Grade A,JNC8 推荐 1,若治疗后SBP较低(如140 mm Hg)且能耐受治疗,无影响健康或生活质量的不
6、良反应,则无需调整治疗方案 (E级推荐),Corollary Recommendation In the general population aged 60 years or older, if pharmacologic treatment for high BP results in lower achieved SBP (for example,140 mm Hg) and treatment is not associated with adverse effectson health or quality of life, treatment does not need to be
7、 adjusted. Expert Opinion Grade E,JNC8 推荐 2,对60岁的高血压患者,DBP90 mm Hg即需启动降压药物治疗,目标DBP90 mm Hg: 30-59岁患者(A级推荐);18-29岁患者(E级推荐),In the general population younger than 60 years, initiate pharmacologic treatment to lower BP at DBP of 90 mm Hg or higher and treat to a goal DBP of lower than 90 mm Hg. For age
8、s 30 through 59 years, Strong Recommendation Grade A For ages 18 through 29 years, Expert Opinion Grade E,JNC8 推荐 3,对60岁的高血压患者,SBP140 mm Hg即需启动降压药物治疗,目标SBP 140 mm Hg (E级推荐),In the general population younger than 60 years, initiate pharmacologic treatment to lower BP at SBP of 140 mm Hg or higher and
9、 treat to a goal SBP of lower than 140 mm Hg. Expert Opinion Grade E,JNC8 推荐 4,对18岁伴慢性肾病(CKD)的高血压患者,SBP140 mm Hg或DBP90 mm Hg即需启动降压药物治疗,目标血压140/90 mm Hg (E级推荐),In the population aged 18 years or older with CKD, initiate pharmacologic treatment to lower BP at SBP of 140 mm Hg or higher or DBP of 90 mm
10、 Hg or higher and treat to goal SBP of lower than 140 mmHg and goal DBP lower than 90 mm Hg. Expert Opinion Grade E,JNC8 推荐 6,在非黑种人高血压患者(包括合并糖尿病患者)中,起始降压药物应包含噻嗪类利尿剂、CCB、ACEI或ARB (B级推荐),In the general nonblack population, including those with diabetes, initial antihypertensive treatment should includ
11、e a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). Moderate Recommendation Grade B,JNC8 推荐 5,对18岁伴糖尿病的高血压患者, SBP140 mm Hg或DBP90 mm Hg即需启动降压药物治疗,目标血压140/90 mm Hg (E级推荐),In the population aged 18 years or ol
12、der with diabetes, initiate pharmacologic treatment to lower BP at SBP of 140 mm Hg or higher or DBP of 90 mm Hg or higher and treat to a goal SBP of lower than 140 mm Hg and goal DBP lower than 90 mm Hg. Expert Opinion Grade E,JNC8 推荐 7,在黑种人高血压患者(包括合并糖尿病患者)中,起始降压药物应包含噻嗪类利尿剂或CCB 普通黑种人群(B级推荐) 合并糖尿病的黑
13、种人群(C级推荐),In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. For general black population: Moderate Recommendation Grade B For black patients with diabetes: Weak Recommendation Grade C,JNC8 推荐 8,对18岁伴CKD的
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