血脂治疗与临床指南ppt课件.ppt

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*TreatmentdeterminedbyhighestBPcategory†TreatpatientswithchronickidneydiseaseordiabetestoBPgoalof<130/80mmHg‡Initialcombinedtherapyshouldbeusedcautiouslyinthoseatriskfororthostatichypotension
SBP=systolicbloodpressure;DBP=diastolicbloodpressure;ACEI=angiotensin-convertingenzymeinhibitor;ARB=angiotensinreceptorblocker;BB=b-blocker;CCB=calciumchannelblocker
-5233.
InitialDrugTherapy
BPClassification
SBP*(mmHg)
DBP*(mmHg)
LifestyleModification
WithoutCompellingIndications
WithCompellingIndications
Normal
<120
and<80
Encourage
Noantihypertensivedrugindicated.
Drug(s)forcompellingindications.†
Prehypertension
120–139
or80–89
Yes
Stage1hypertension
140–159
or90–99
Yes
Thiazide-typediuretic,ARB,BB,CCB,orcombination.
Drug(s)forcompellingindications.†Otherantihypertensivedrugs(diuretic,ACEI,ARB,BB,CCB)asneeded.
Stage2hypertension
³160
or³100
Yes
Two-drugcombinationformost‡(usuallythiazide-typediureticandACEIorARBorBBorCCB).
JNC7:TreatmentAlgorithmforHypertension
SBP=systolicbloodpressure;DBP=diastolicbloodpressure;ACEI=angiotensin-convertingenzymeinhibitor;ARB=angiotensinreceptorblocker;BB=b-blocker;CCB=calciumchannelblocker
-5233.
Optimizedosagesoraddadditionaldrugsuntilgoalbloodpressureisachieved.
Considerconsultationwithhypertensionspecialist.
Notatgoalbloodpressure
Withoutcompellingindications
Stage1hypertension
(SBP140–159orDBP90–99mmHg)
Thiazide-typediureticformost.
MayconsiderACEI,ARB,BB,CCB,orcombination.
Stage2hypertension
(SBP³160orDBP³100mmHg)
Two-drugcombinationformost(usuallythiazide-typediureticandACEIorARBorBBorCCB).
Lifestylemodifications
Notatgoalbloodpressure(<140/90mmHg)(<130/80mmHgforthosewithdiabetesorchronickidneydisease)
Initialdrugchoices
Withcompellingindications
Drugsforcompellingindications
Otherantihypertensivedrugs(diuretic,ACEI,ARB,BB,CCB)asneeded.
ATPIII:NewFeaturesofGuidelines—FocusonMultipleRiskFactors
PersonswithdiabeteswithoutCHDraisedtolevelofCHDriskequivalent
Framingham10-yearabsoluteCHDriskprojectionsusedtoidentifycertainpatientswith2riskfactorsformoreintensivetreatment
Personswithmultiplemetabolicriskfactors(themetabolicsyndrome)identifiedascandidatesforintensifiedtherapeuticlifestylechanges(TLC)
ExpertPanelonDetection,Evaluation,andTreatmentof;285:2486-2497.
ATPIII:NewFeaturesofGuidelines—ApplyingtheRecommendations
Completefastinglipoproteinprofile(TC,LDL-C,HDL-C,TG)recommendedaspreferredinitialtest
Useofplantstanols/sterolsandviscousfiberencouragedastherapeuticdietaryoptionstoenhanceLDL-Clowering
Strategiespresentedtoimproveadherencetotherapeuticlifestylechanges(TLC),drugtherapies
IntensiveTLCrecommendedforpersonswiththemetabolicsyndrome
Non–HDL-C(TCminusHDL-C)goalrecommendedassecondarytargetforpersonswithhighTGlevels(200mg/dL)
ExpertPanelonDetection,Evaluation,andTreatmentof;285:2486-2497.
ATPIII:FeaturesSharedwithATPII
LDL-Cloweringremainsprimarygoaloftherapy
HighLDL-C(160mg/dL)consideredtargetforLDL-C–loweringdrugtherapy
IntensiveLDL-CloweringemphasizedinpersonswithCHD
3riskcategoriesfordifferentLDL-CgoalsandintensitiesofLDL-C–loweringtherapy
Subpopulations(otherthanmiddle-agedmen)identifiedfordetectionofhighLDL-C,clinicalintervention:youngadults;postmenopausalwomen;olderpersons
Weightloss,physicalactivityemphasizedtoreduceriskinpersonswithelevatedLDL-C
ExpertPanelonDetection,Evaluation,andTreatmentof;285:2486-2497.
ATPIII:LDL-C,HDL-C,TCClassification
ExpertPanelonDetection,Evaluation,andTreatmentof;285:2486-2497.
LDL-C(mg/dL)
<100
Optimal
100–129
Above,nearoptimal
130–159
Borderlinehigh
160–189
High
190
Veryhigh
HDL-C(mg/dL)
<40
Low
60
High
TC(mg/dL)
<200
Desirable
200–239
Borderlinehigh
240
High
ATPIII:MajorCHDRiskFactorsOtherThanLDL-C
Cigarettesmoking
Hypertension:BP140/90mmHgoronantihypertensivemedication
LowHDL-C:40mg/dL*
FamilyhistoryofprematureCHD(1st-degreerelative):
malerelativeage55years
femalerelativeage65years
Age
male45years
female55years
*HDL-C60mg/dLisanegativeriskfactorandnegatesoneotherriskfactor.
ExpertPanelonDetection,Evaluation,andTreatmentof;285:2486-2497.
ATPIII:AdditionalCHDRiskFactors
ExpertPanelonDetection,Evaluation,andTreatmentof;285:2486-2497.
Life-habitriskfactors:targetsforintervention;notusedtosetlowerLDL-Cgoal
– obesity– physicalinactivity– atherogenicdiet
Emergingriskfactors:canhelpguideintensityofrisk-reductiontherapy;donotcategoricallyalterLDL-Cgoals
– lipoprotein(a) – homocysteine– impairedfastingglucose – prothromboticand– subclinicalatherosclerotic proinflammatoryfactors disease
ATPIII:AssessmentofRisk
ForpersonswithoutknownCHD,otherformsof
atheroscleroticdisease,ordiabetes:
Countthenumberofriskfactors.
UseFraminghamscoringforpersonswith2riskfactors*todeterminetheabsolute10-yearCHDrisk.
*Forpersonswith0–1riskfactor,Framinghamcalculationsarenotnecessary.
ExpertPanelonDetection,Evaluation,andTreatmentof;285:2486-2497.
ATPIII:RiskCategories,LDL-CGoals
RiskCategory
LDL-CGoal(mg/dL)
CHDandCHDriskequivalents(10-yearrisk>20%)
<100
2riskfactors(10-yearrisk20%)
<130
0–1riskfactor*
<160
*Almostallpeoplewith0–1riskfactorhavea10-yearrisk<10%;thus,Framinghamriskcalculationsarenotnecessary.
ExpertPanelonDetection,Evaluation,andTreatmentof;285:2486-2497.