降壓治療策略與目標(biāo)顏與進(jìn)展降壓治療策略研究的重點(diǎn)●血壓水平與心血管危險(xiǎn)●降壓治療與心血管危險(xiǎn)控制治療益處及來源(why)治療對(duì)象(who)治療目標(biāo)水平(what)治療方案(which血壓、年齡與腦卒中死亡率(100萬人群資料分析)256Aes50-5950-59T090100110UsualsystolicbloodUsualdiastolicbloodPressure(mmHg)ncct2019,360:1903血壓、年齡與冠心病死亡率(100萬人群資料分析)Ageatrist256Years70-79Years40-49T090100110UsualsystolicbloodUsualdiastolicbloodPressure(mmHg)ncct2019,360:1903收縮壓20mmHg差值對(duì)心血管危險(xiǎn)影響A:usualsystolicbloodpressure(2115mmHgAgeatStroke036(0.320038(035-0.40)60-69043(0.41-0.45)70-794320.0(0.48-0.52)IHD0.49(0450.53)0.50(049-0.52)60-69104500.540.53-0.55)060(0.58-061)0.67(0.64-0.70)Other043(0.38-0.48)50-5913770.50(0470.54)25490.53(0.51-0.56)70-7932270.64(0.61-0.67)80-8922510.70(0.65075)0250.350.50.71.0Hazardratio(95%ci)for20mmHgncct2019,360:1903Lowerusualsystolicbloodpressur舒張壓10mmHg差值對(duì)心血管危險(xiǎn)影響B(tài):usualdiastolicbloodpressure(275mmHg)CauseAgeatOfdeathrisk(yearsStroke3480.35(030-0.40)1243034(0320.37)0.40(0.3804270-7939150.48(045051)23400.63(0.580.69)40-491114047(0.43-0.51)0.52(0.50-0.5560-6992890.56(0.540.58)0.70(0.65-074)Other40-490.43(0370.50)vascular0.48(0.440.5260-6922200.490.46-0.53)70-7928530.61(0.570.66)80-891976071(0.64079)0.250.35050.71.0Hazardratio(95%oci)for10mmHgncct2019,360:1903Lowerusualdiastolicbloodpressure血壓參數(shù)預(yù)測(cè)腦卒中和冠心病死亡率的相對(duì)能力腦卒中冠心病SBP89%93%DBP3%73%PP37%43%MAP100%97%MidBP100%100%Lancet2019,360:1903ESRD危險(xiǎn)性隨血壓升高而增加血壓分級(jí)患者ESRD數(shù)目年齡校正后的校正后的RR(n=322554)(n=814)每10萬人年發(fā)生率(95%CD)理想61089515.31.0正常816216.61.200.8-1.7)正常高值lI1.9(1.4-2.7)高血壓1級(jí)(輕度)8568427521.02級(jí)(中度)2345915843.66.0(43-8.4)3級(jí)(重度)546411.2(7.7-16.2)4級(jí)(極重度)14292.1(142-34.3)KlagM,WheltonPK,RandalBLetal,NewEngJMed.2019;334:14-18血壓水平的分類和定義(JNC7)分類收縮壓mmHg)舒張壓mmHg)正常血壓<120<80高血壓前期120-139或80-89高血壓1級(jí)140-159或90-99高血壓2級(jí)≥160或≥100血壓水平的分類和定義(ESHESC2019)分類收縮壓mmHg)舒張壓mmHg)理想血壓