西氏内科学 Cecil Medicine：高血压 Arterial Hypertension

Cecil medicine Section viii Chapter 66 Arterial Hypertension Prof. Shen-Jiang Hu

1 Cecil Medicine Section VIII Chapter 66 Arterial Hypertension Prof. Shen-Jiang Hu

Question a How to measure the blood pressure

2 Question ◼ How to measure the blood pressure?

made by a cambridge Reverend, stephen Hales, in 1733. he measured blood pressure by inserting the end of a long glass tube into the carotid artery of a horse and noting that the blood came up the tube to a height of nine feet eight inches, which was the blood pressure of the horse

3 made by a Cambridge Reverend, Stephen Hales, in 1733. He measured blood pressure by inserting the end of a long glass tube into the carotid artery of a horse and noting that the blood came up the tube to a height of nine feet eight inches, which was the blood pressure of the horse

It took Riva-Rocci, together with a prussian general called Korotkoff, to develop the modern sphygmomanometer which was introduced into clinica practice in about 1905. The device that probably many of us still use today to measure blood pressure has changed very little from this early device. 4

4 It took Riva-Rocci, together with a Prussian general called Korotkoff, to develop the modern sphygmomanometer which was introduced into clinical practice in about 1905. The device that probably many of us still use today to measure blood pressure has changed very little from this early device

Blood pressure has a unimodal distribution in the population sS次 Prevalence of hypertension by different cut points 290:253% 295:145% 2100:84% 2105=47% 2110:29% 2115:14% 5060708090100o120130 D/ASTOL/C BL000 PRESSURE (mm Hg/ igure 1.8.Frequency distribution of diastolic blood pressure measured at hoo Program Cooperative Group. The Hyper- me screening (n=158, 906, aged 30 to 69 ears).(Reprinted with permission from Hypertension Detection and Follow ension Detection and Follow Up Program. A progress report. Circ Res 1977: 40(Suppl 1) 1106-1109.)

5 Blood Pressure has a unimodal distribution in the Population

Question Is it important if the person has a higher blood pressure?

6 Question: ◼ Is it important if the person has a higher blood pressure?

Knowledge about risk and treatment of hypertension 2003 1970 JNC VIl: HBP to target BP is central for reduction of the Hypertension and Stroke total risk of cv events 1980 JNC I: DBP for diagnosis WHO: HBP should be and treatment of reduced to target BP. hypertension 1961 2006 Framingham heart 1992 JNC V: SBP and dbp is 2005 Study: Hypertension and chd same important for China guideline for hypertension hypertension: HBP should 1978 be reduced to target BP World Health Organization (HO): Treatment of Hypertension, firstly 7

7 Knowledge about risk and treatment of hypertension Framingham Heart Study: Hypertension and CHD 1961 Hypertension and Stroke 1970 World Health Organization (WHO):Treatment of Hypertension, firstly 1978 JNC II: DBP for diagnosis and treatment of hypertension 1980 JNC V: SBP and DBP is same important for hypertension 1992 JNC VII：HBP to target BP is central for reduction of the total risk of CV events. 2003 China guideline for hypertension: HBP should be reduced to target BP 2005 WHO: HBP should be reduced to target BP. 2006

The relationship between DBP and Cardiovascular events CHD Stroke 4 4.00 2.00 200 1.00 100 0.50 0.50 0.25 0.25 80 100 70 90 100 Approximate mean usual DBP (mm Hg)

8 The Relationship between DBP and Cardiovascular Events

Elevated SBP Increases CVD Mortality Stroke Age at risk THD Age at risk 256 80-89 years256 80-89 years 8128 70-79 years 128 70-79 years 64 60-69 years 64 60-69 years 32 A50-59 years 32 50-59 years 16 16 d40-49 years 8 0 120140160180 120140160180 Usual SBP(mm Hg) Usual SBP(mm Hg) IHD=ischemic heart disease: CVD=cardiovascular disease Prospective Studies Collaboration. Lancet. 2002; 360: 1903-1913

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Complications of Hypertension Heart Atrial Failure Hypertrophy MI Fibrillation Aortic Hypertensive Dissection Encephalopathy Hypertension CHD Dementia Intracerebral Chronic renal failure Ischemic Hemorrhage Cerebral Infarction

10 Hypertension Atrial Fibrillation Aortic Dissection Dementia Chronic Renal failure Heart Failure LV Hypertrophy MI Hypertensive Encephalopathy CHD Intracerebral Hemorrhage Ischemic Cerebral Infarction Complications of Hypertension