内科学高血压(英文)

High Blood Pressure,1. The commonest cardiovascular disease (it involves more than 30% people in developed countries and 8-30% Chinese, it is 18.8% morbidity and at least 200 million people adults are involved based on epidemiological survey in 2001). 2. Its main problems are secondary damages of heart, kidneys and brain ( main risk factor of heart diseases, cerebral stroke, renal failure and aorta diseases),DESCRIPTION,Hypertension High blood pressure Essential hypertension Primary hypertension Secondary Hypertension,Scientific Terms,DEFINITIONS,Conceptual definition Operational definition,Increased Intraartery Blood Pressure,Distribution of Blood Pressure in the Population,DEFINITION OF HYPERTENSION (WHO/IHA, 2003),Definitions and classification of blood pressure levels (mmHg) Category Systolic Diastolic Optimal 120 80 Normal 120129 8084 High normal 130139 8589 Grade 1 hypertension (mild) 140159 9099 Grade 2 hypertension (moderate) 160179 100109 Grade 3 hypertension (severe) 180 110 Isolated systolic hypertension 140 90,Comparison of the definitions or Criteria of Hypertension at Different Eras,SBP 140 or 170 (twice) (once） DBP=90 or 100 (twice) (once）,Normal：140/90 Border：140-159/90-94 Hypertension：160/95,Optimal： 120/80 Normal： 130/85 high Normal ： 130-139/85-89 Hypertension： 140/90 Isolated Systoloc HBP: BP140 DBP 90,1959 1979 1999,Definition and Classification of Hypertension of Chinese Hypertension League (2010),Classification Systolic BP Diastolic BP (mmHg) (mmHg),Normal 120 80 High normal 120-139 80-89 Hypertension 140 90 Grade 1 (mild) 140-159 90-99 Grade 2 (moderate) 160-179 100-109 Grade 3 (severe) 180 110,Isolated Systolic Hypertension 140 90,中国高血压指南（2004，2010）,How Important is Hypertension (1),beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120139 mm Hg or diastolic BP 8089 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD;,JNC-7,How important is Hypertension (2),For uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (ACE inhibitors, ARBs, beta-blockers, calcium channel blockers);,JNC-7,How important is Hypertension (3),two or more antihypertensive medications will be required to achieve goal BP (140/90 mm Hg, or 130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan.,JNC-7,血压水平的新定义和分类比较,中国高血压指南（2010）,Eur Heart J. 2007;28(12):1462-536.,Hypertension. 2003;42:12061252,How to measure Blood pressure,1. requirements for cuff: Children: 7-8 cm wide, adults: 12-13 cm wide and 23 cm long cover at least 2/3 of up arm and 80% of circle of arm 2. correct place of cuff: 2.5cm over elbow to leave a space for stethoscope; 3. measuring method: inflation height over 20 mmHg; deflation speed: 2mmHg/sec Korotkoff sound and Diastolic blood pressure,How to measure Blood pressure,4. For the obese people: use forearm 5. Before measuring,: be quiet and relax at RT for 5 min; 6. How to assess BP (confirmation): Read at least 2 times and differences is less than 5mmHg. Take measurement at least 2 weeks interval,7. Ambulatory Blood pressure Monitoring (ABPM): diagnosis and assessment of therapeutic efficiency Diagnosis criteria: Duration Normal 95th percent Hypertension 24hrs 130/80 133/82 135/85 Day 135/85 139/87 140/90 Night 120/70 124/74 125/75,Morbidity is different in different countries Developed Countries: 20%, Blacks are higher than white. For example, approximately 50 million adult Americans have hypertension in USA. Developing Countries: 10-20%, and keep increasing; In China, the morbidity of hypertension is approximately 15% based on the Survey in 2001, and Northern China is higher than in Southern China and Cities is higher than in Countryside. (5.11%, 7.73%, 11.88% and 18.8% in 1959, 1979, 1991 and 2001, respectively),Epidemiology (1),Epidemiology (2),The overwhelming majority of people will have hypertension befor