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1、What Is Hypertension?Blood Pressure(mm Hg)CategorySystolicDiastolic120and 80Normal120-139or 80-89Prehypertension 140-159or 90-99Stage 1 hypertension 160or 100Stage 2 hypertension JNC 7 DefinitionsChobanian AV,et al.Hypertension 2003;42:1206-52*Individuals aged 40-69 years,starting at blood pressure
2、115/75 mm Hg.CV,cardiovascular;DBP,diastolic blood pressure;SBP,systolic blood pressure.Chobanian AV et al.JAMA.2003;289(19):2560-2572.Lewington S et al.Lancet.2002;360(9349):1903-1913.Cardiovascular Mortality Risk Doubles With Each 20-mm Hg SBP or 10-mmHg DBP Increment*CardiovascularmortalityriskSB
3、P/DBP(mm Hg)012345678115/75135/85155/95175/1052x4x8xNon-Hispanic WhiteNon-Hispanic BlackMexican AmericanMen(age,years)Hypertension*Prevalence(%)18-3940-5960020406080100Women(age,years)18-3940-5960020406080100Hypertension*Prevalence(%)*Hypertension defined as a BP of 140/90 mm Hg or reported use of a
4、ntihypertensives.Error bars indicate 95%confidence intervals.Data are weighted to the US population.Hajjar I,Kotchen TA.JAMA.2003;290:199-206.Prevalence of Hypertension Increases with Age:NHANES 1999-2000 DataNHANES=National Health and Nutrition Examination Survey.Fields,LE et al.Hypertension.2004;4
5、4:398-404.Increasing Prevalence of Hypertension:Rise From 1988 to 2000(NHANES)00.511.522.533.544.55Non-Hispanic WhitesNon-Hispanic BlacksMexicanAmericans%Increase(19881994 to 19992000)MenWomen Blacks have a higher prevalence and incidence of hypertension than whites.Most studies in the United Kingdo
6、m and the United States report a higher prevalence and lower awareness of hypertension in black people than in white people.In Mexican-Americans,the prevalence and incidence of hypertension is similar to or lower than in whites.NHANES III reported an age-adjusted prevalence of hypertension at 20.6%i
7、n Mexican-Americans and 23.3%in non-Hispanic whites.Group HTN Prevalence White 21.2%Black/African-American 29.2%Hispanic/Latino 19.6%Asians 16.9%Native Hawaiian/other Pacific Islander 20.7%American Indians/Alaska Natives 25.4%American Heart Association Heart Disease and Stroke Statistics 2007Hyperte
8、nsion Prevalence by Ethnic/Minority GroupsContributing Factors:Social,Environmental,or Genetic?Environmental factors ultimately related to race(e.g.socioeconomic disadvantage,less access to health care)play roles in causing and sustaining hypertension 1,2 Despite similar African heritage,Africans li
9、ving in Africa or West Indies have much less hypertension than African Americans 3,4 In rural Africa,hypertension prevalence is very low and blood pressure does not rise with age as it does in all ethnic groups in US 31 Cooper RS,Rotimi CN,Ward R.The puzzle of hypertension in African-Americans.Sci A
10、m.1999;280:5662.2 Geronimus AT,Bound J,Waidmann TA,et al.Excess mortality among blacks and whites in the United States.N Engl J Med.1996;335(21):15521558.3 Cooper R,Rotimi C,Ataman S,et al.The prevalence of hypertension in seven populations of west African origin.Am J Public Health.1997;87:160168.4
11、Ordunez-Garcia PO,Espinosa-Brito AD,Cooper RS,et al.Hypertension in Cuba:evidence of a narrow black-white difference.J Hum Hypertens.1998;12:111116.BP Reductions as Small as 2 mm Hg Reduce Risk of CV Events by Up to 10%Meta-analysis of 61 prospective,observational studies 1 million adults 12.7 milli
12、on person-yearsProspective Studies Collaboration.Lancet.2002;360:1903-1913.2 mm Hg decrease in mean SBP10%reduction in risk of stroke mortality7%reduction in risk of CHD mortalityBPLTTC Meta-analysis:Stroke and CHDBlood Pressure Lowering Treatment Trialists Collaboration.Lancet.2003;362:1527-1535.JN
13、C7 Algorithm forTreatment of HypertensionNot at Goal BP 140/90 mm Hg for most 130/80 for those with diabetes or CKDInitial Drug ChoicesDrug(s)for compelling indications+BP meds as neededCompelling IndicationsLifestyle ModificationsStage 2 BP 160/100 2-drug combo for most(diuretic+ACEI,or ARB,or BB,o
14、r CCB)Stage 1 140-159/90-99 Diuretics for most;consider ACEI,ARB,B,CCBNo Compelling IndicationsNot at Goal BPOptimize dosages or add drugs until goal BP is achieved.Consider hypertension specialist consult.Chobanian AV,et al.JAMA.2003;289:2560-2572.ACEI=ACE inhibitorCCB=calcium channel blockerARB=an
15、giotensin receptor blocker B=-blockerCKD=chronic kidney diseaseJNC 7 Compelling IndicationsChobanian AV,et al.JAMA.2003;289:2560-2572.Heart failurePost-MIHigh CHD riskDiabetesChronic kidneydiseaseRecurrent strokepreventionBACEIARB CCBAADiureticAA=aldosterone antagonist AHA Perspective/Hypertension M
16、anagement and BP Goals Summary of Main Recommendationsadapted from Rosendorff C,et al.Circulation 2007;115:published onlineArea of concernBP Target(mm Hg)Lifestyle modificationSpecific Drug IndicationsGeneral CAD prevention140/90YesAny effective antihypertensive drug or combinationHigh CAD risk*130/80YesACEI or ARB or CCB or thiazide or combinationStable angina130/80Yes-blocker and ACEI or ARBUA/NSTEMI130/80Yes-blocker and ACEI or ARB STEMI130/80Yes-blocker and ACEI or ARB LVD120/80YesACEI or AR
