文档介绍：最新高血压指南的几个问题
内容提要
关于血压水平的定义和分类
关于危险度分层
关于卫生经济学
关于用药问题
高血压患者危险分层--WHO/ISH 1999
注:《1999年中国高血压防治指南》的危险分层参考的是
1999年WHO/ISH指南
影响高血压患者预后的因素
高血压患者危险分层--2003欧洲高血压指南
III级高血压
II级高血压
I级高血压
正常血压高值
正常血压
其他危险因素和疾病
++++
++++
++++
++++
+++
关联临床状况
++++
+++
+++
+++
++
3危险因素或糖尿病或靶器官损害
++++
++
++
+
+
1-2 危险因素
+++
++
+
±
±
0 危险因素
±:平均危险;+:低度危险增加;++:中度危险增加;+++:高度危险增加;++++:极高度危险增加
Risk factor similar as 1999 guidelines except :
obesity as a separate criterion is added
血压分类--JNC-VI(1997)
---------------------------------------------------------
类别收缩压(mm Hg) 舒张压(mm Hg)
---------------------------------------------------------
理想血压<120 <80
正常血压 120 - 129 80 - 84
正常高值 130 - 139 85 - 89
1级高血压 140 – 159 90 – 99
亚组:临界高血压 140 - 149 90 - 94
2级高血压 160 - 179 100 -109
3级高血压180 110
单纯收缩期高血压140 <90
亚组:临界收缩期高血压 140 - 149 <90
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1. Distribution of NHANES I Epldemiologic Follow-up Study Participants with a High-Normal BP or Hypertension at Baseline According to BP Lovel and Risk Categorization
640()
107()
257()
276()
Risk Group A
1366()
5084()
Total
483()
1505()
≥160/ ≥100
609()
2208()
140-159/90-99
300()
1371()
130-139/85-89
Risk Group C
Risk
Group B
SBP/DBP, mmHg
Values are n (%)
2. Estimated Effect of a 12mmHg Reduction in SBP Over 10 years on the Number-Needed-to-Treat to Prevent a Cardiovascular Disease Event Among NHANES I Epidemiologic Follow-Up Study Participants According to Baseline BP Level and Category of Presumed Cardiovascular Risk
Risk Group C
Risk Group B
Risk Group A
8
16
7
13
10
16
≥160/ ≥100
9
17
11
19
20
33
140-159/90-99
10
19
13
23
25
41
130-139/85-89
Corrected*
Uncorrected
Corrected*
Uncorrected
Corrected*
Uncorrected
SBP/DBP, mmHg
See test or Table 1 for deflnition of risk groups.
*Corrected for regression dilution bias using a reliability coefficien