重庆医科大学：《内科学》课程教学课件（PPT讲稿）hypertension

HYPERTENSION Luo kailiang,MD,Prof. The Second Affiliated Hospital Chongqing University of Medical Sciences

HYPERTENSION Luo kailiang, MD, Prof. The Second Affiliated Hospital Chongqing University of Medical Sciences

1.Definition Hypertension: SBP≥140 or DBP≥90mmHg primary hypertension (essential hypertension):In 95%of cases no cause can be found. Secondary Hypertension: In 5%a cause can be found. 2

2 1. Definition Hypertension: SBP > 140 or DBP > 90mmHg primary hypertension (essential hypertension): In 95% of cases no cause can be found. Secondary Hypertension: In 5% a cause can be found

Definitions and classification of blood pressure level (WHO/ISH,1999) Category SBP(mmHg) DBP(mmHg） Optimal <120 <80 Normal <130 <85 High normal 130~139 85≈89 Grade 1 HPN(mild) 140~159 9099 Grade 2 HPN (morderate) 160~179 100~109 Grade 3 HPN(severe) ≥180 ≥110 ISH ≥140 90

3 Definitions and classification of blood pressure level (WHO/ISH,1999） Category SBP(mmHg) DBP(mmHg) Optimal <120 <80 Normal <130 <85 High normal 130～139 85～89 Grade 1 HPN(mild) 140～159 90～99 Grade 2 HPN(morderate) 160～179 100～109 Grade 3 HPN(severe) ≥180 ≥110 ISH ≥140 <90

When a patient's systolic and diastolic blood pressures fall into different categories,the higher category should apply. Blood pressure is a continuous variable, The definition of hypertension has been arbitrarily set as:That blood pressure above which the benefits of treatment outweigh the risks in term of morbidity and mortality

4 ▪ When a patient’s systolic and diastolic blood pressures fall into different categories, the higher category should apply. ▪ Blood pressure is a continuous variable, The definition of hypertension has been arbitrarily set as: That blood pressure above which the benefits of treatment outweigh the risks in term of morbidity and mortality

A diagnosis of high blood pressure should not be based on a single reading,except when it is extremely high-for example, above 170-180/105-110.Otherwise several measurements taken over a period of time are generally needed to confirm a diagnosis. 5

5 ▪ A diagnosis of high blood pressure should not be based on a single reading, except when it is extremely high—for example, above 170–180/105–110. Otherwise several measurements taken over a period of time are generally needed to confirm a diagnosis

30 5 30 25 25 2. 20 20 2 3 5 1051000 15 1.5 2 10 10 1 Adjusted relative risk 5 0.5 0 0 <110 00-19⊙9149 210 120 30 40 ☑088] SBP,mm Hg DBP,mm Hg MRFIT:Arch Intern Med 1993;153:598

6 SBP, mm Hg % of men 30 25 20 15 10 5 0 Adjusted relative risk 5 4 3 2 1 0 DBP, mm Hg % of men 30 25 20 15 10 5 0 Adjusted relative risk 3 2.5 2 1.5 1 0.5 0 MRFIT: Arch Intern Med 1993; 153:598

The continuous relationship between the level of blood pressure and the risk of cardiovascular events,and arbitrary nature of the definition of hypertension have contributed to the variation in the definitions issued by various national and international authorities. 7

7 The continuous relationship between the level of blood pressure and the risk of cardiovascular events, and arbitrary nature of the definition of hypertension have contributed to the variation in the definitions issued by various national and international authorities

JNC-7 Classification of BP Category Systolic Diastolic Normal 160 Or ≥100 Stage 2

8 JNC-7 Classification of BP Category Systolic Diastolic Normal 160 Or > 100

2.Epidemiology

2. Epidemiology

Prevalence of hypertension in adult 28.79% 20 15 11.88% 10 7.736 5.11% 5 0 1959 1979 1991 1999-2000 CHINA USA

10 11.88% 7.73% 5.11% Prevalence of hypertension in adult 1959 1979 1991 30 25 20 15 10 5 0 1999~2000 CHINA USA 28.79％