中国医科大学附属第一医院：《内科学》课程教学资源（PPT课件讲稿，双语版）Hypertension

Hypertension Concept: systemic blood pressure increased, target organ damaged (brain, heart, eye, kidney, vessel), metabolism changed Essential hypertension(ET): unknown cause 95%, hypertensive disease Secondary hypertension(ST): known cause, 1 5%

Hypertension • Concept: systemic blood pressure increased, target organ damaged(brain,heart , eye, kidney, vessel), metabolism changed • Essential hypertension(ET): unknown cause, 95% ，hypertensive disease. • Secondary hypertension(ST): known cause, 1- 5%

Epidemiology Incidence increasing rapidly, 11.26% in >15years old in China in 1999 incidence different among race, age, sex, area(y 南北,高原,发达地区等) 知晓率,服药率,控制率 lower

Epidemiology • Incidence increasing rapidly, 11.26% in >15years old in China in 1999 • incidence different among race, age,sex, area(城乡， 南北，高原，发达地区等） • 知晓率，服药率，控制率 lower

中国高血压的现状和流行趋势 199普查 患病率1126%;10年上升25% 90年代初有高血压患者9500万 目前预计>1亿 998年 脑血管病居城市居民死亡原因第二位, 农村居首位, 脑卒中的主要危险因素为高血压 伴随 糖尿病患病率;吸烟率↑; 超重↑;冠心病↑

中国高血压的现状和流行趋势 • 1999年普查 - 患病率 11.26%; 10年上升 25% - 90年代初有高血压患者9500万 - 目前预计> 1亿 • 1998年 - 脑血管病居城市居民死亡原因第二位， 农村居首位， - 脑卒中的主要危险因素为高血压 • 伴随 - 糖尿病患病率 ； 吸烟率 ； 超重 ； 冠心病

Pathogenesis of Hypertension Hereditary and gene hypothesis: 20-40% population have hereditary tendency candidate hypertensive gene 5-8 .Environmental factors hypoweight, overweight, high salt diet drunk

Pathogenesis of Hypertension • Hereditary and gene hypothesis： 20-40% population have hereditary tendency candidate hypertensive gene 5-8 • Environmental factors： hypoweight，overweight, high salt diet, drunk

Pathophysiology of Hypertension Psychological and psychopathic factors Renin -angiotensin aldosterone system(RAAS) Sodium and hypertension Abnormality of vascular endothelium (ET, NO Angll, PG12, etc) Insulin resistance revascularization other (obesity, smoking, drinking, hypocalcium, hypomagnesium, hypopotassium)

Pathophysiology of Hypertension • Psychological and psychopathic factors • Renin –angiotensin aldosterone system（RAAS） • Sodium and hypertension • Abnormality of vascular endothelium（ET，NO， AngII, PGI2, etc) • Insulin resistance • revascularization • other（obesity，smoking，drinking，hypocalcium, hypomagnesium, hypopotassium）

Pathophysiology of Hypertension BPECO X SVR CO: blood volume, HR, myocardial contractility SVR:阻力小动脉结构改变 血管壁顺应性降低 血管的舒缩状态改变

Pathophysiology of Hypertension • BP=CO X SVR • CO: blood volume，HR，myocardial contractility • SVR：阻力小动脉结构改变 血管壁顺应性降低 血管的舒缩状态改变

Clinical Manifestation Early: asymptom, great BP variation headache, dizziness, palpitation, fatigue A2↑s4, aortic area sM Late: manifestation of complications brain, heart, eye, kidney, vessel damage

Clinical Manifestation • Early: asymptom， great BP variation headache，dizziness，palpitation，fatigue A2 S4，aortic area SM • Late: manifestation of complications brain, heart，eye, kidney, vessel damage

Clinical Manifestation Target organ related to accelerated As related to BP level heart angina、MI,SD heart failure Brain IA, brain thrombosis cerebral hemorrhage encephalopath Kidney renal angiopathy renal arteriolosclerosis renal failure Artery blocking lesion aortic dissection

Clinical Manifestation Target organ related to accelerated AS related to BP level heart angina、MI，SD heart failure Brain TIA， brain thrombosis cerebral hemorrhage encephalopathy Kidney renal angiopathy renal arteriolosclerosis renal failure Artery blocking lesion aortic dissection

Clinical Manifestation Most common complications are from brain, 4-6 times faMI。 Include: TIA, brain thrombosis, brain infarction(包括腔隙 性脑梗塞), encephalopathy, cerebral hemorrhage

Clinical Manifestation Most common complications are from brain， 4-6 times of AMI 。 Include: TIA， brain thrombosis，brain infarction（包括腔隙 性脑梗塞）, encephalopathy ， cerebral hemorrhage

Hypertension and Stroke A. Both SBP DBP positively related to stroke risk .l DBP< 5mmHg, stroke risk decrease 35-40% 不存在这样一个DBP的低限水平,低于这一水平时 stroke risk不再继续下降。 Following the aging, stroke incidence increase rapidly 血压水平与脑出血和脑梗塞都有相关关系,但似乎与脑出 血的关系更陡直一些

Hypertension and Stroke • Both SBP & DBP positively related to stroke risk • DBP< 5mmHg, stroke risk decrease 35 - 40%。 • 不存在这样一个DBP的低限水平，低于这一水平时， stroke risk不再继续下降。 • Following the aging， stroke incidence increase rapidly。 • 血压水平与脑出血和脑梗塞都有相关关系，但似乎与脑出 血的关系更陡直一些