文档介绍：Clinical Management of Hypertensive Heart Disease:Preventing Heart Failure
Clyde W. Yancy, MD, , FAHA, FACP
Medical Director, Baylor Heart and Vascular Institute
Chief, Cardiothoracic Transplantation
Baylor University Medical Center
Dallas, Texas
Prevalence of Heart Failure Increases With Age*
*NHANES, 1999-2002.
NHANES=National Health and Nutrition Examination Survey.
Adapted from American Heart Association. Heart Disease and Stroke Statistics—2005 Update. Dallas, TX: American Heart Association; 2005.
0
2
4
6
8
10
20–24
25–34
35–44
45–54
55–64
65–74
75+
Age (yr)
Population (%)
Male
Female
Adapted from Dzau V, et al. Am Heart J. 1991;2(4 pt 1):1244-1263.
Risk factors
Hyperlipidemia
Hypertension
Diabetes
Insulin resistance
Atherosclerosis
LVH
CAD
Myocardial ischemia
Coronary
thrombosis
Myocardial
infarction
Loss of
muscle
Arrhythmia
Sudden
death
Remodeling
Ventricular
dilatation
Heart failure
Death
From Risk Factors to Heart Failure: The Cardiovascular Continuum
A
B
c
D
1 2 4 6 8 10
Risk Factors for CHF Among Hypertensive Subjects*
Risk Factor
Sex
Age- and Risk Factor–Adjusted Hazard Ratio†
(95% CI)
Myocardial infarction
M
F
Angina pectoris
M
F
Diabetes
M
F
Left ventricular hypertrophy
M
F
Valvular heart disease
M
F
CHF=congestive heart failure; CI=confidence interval.
* Based on 165 CHF events in 1707 men and 192 events in 2118 women with hypertension prior to CHF. Based on dynamic model with reclassification of hypertension and risk factors at each follow-up examination. †Adjusted for myocardial infarction, angina pectoris, diabetes, left ventricular hypertrophy, and valvular heart disease.
Adapted from Levy D, et al. JAMA. 1996;275:1557–1562.
STAGE A
At high risk for HF but without structural heart disease or symptoms of HF.
STAGE D
Refractory HF requiring specialized interventions.
STAGE B
Structural heart disease but without signs or symptoms of HF.
STAGE C
Structural heart disease with p