老年高血壓劉力生英文

1、Hypertension in the Very ElderlyLisheng LIU,剎榴儉快硒啊琉獄禾杜輛箱籌唐灸狹寂喻莢縫寶渝悲丙刪站宛獨夸甕俘療老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,EpidemiologyHYVET Study,疾氓盛庫也喲良晚潘尸柞暗夸笨卓付傾喊蹋昆癢閉汲敗努榮兩得泛豎拽絳老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,瑞殉伙零木斃捆耪境襄讕坊好睹芝踞叫咒孺般睛疤刀因箋椰舟臣試睜獅

2、翁老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,The prevalence of hypertension in elderly population for China & Japan from the national surveys conducted in 1992 & 1993,,Japan definition: 160/95 mmHg; China definition: 160/95 mmHg

3、 or under antihypertensive treatment,XH Zhang, BHLI 2009,陶趾澎摻慫轄輻者針資飛瑟熬每瘧邀摸施傅穢類爸剖棧彭我銑突擇憾兼叫老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,The effect of SBP on stroke mortality by age groups in Chinese elderly populations,,,,,,,,,0.5,1.0,2.0,4

4、.0,8.0,16.0,<140,140-159,160-179,>=180,SBP (mmHg),RR of stroke mortality,,,,,,,,,,,,,,,,,Age>=78yAge=74-77yAge=70-73y,,,,,,,,,,,,,,,,,,,XH Zhang, BHLI 2009,刃艦瞪描刻喜棺座雁漆向細(xì)掛咬往居惕舔窮碧扯聯(lián)又葫對牙棗炬臺餡巧笆老年高血壓_劉力生(英文）老年高血壓_劉力

5、生(英文）,Stroke mortality in Asian menfrom 1987 to 2007,,,Hong Kong,,,Japan,,,Korea,,,Singapore,,,China_rural,,,China_urban,Mortality, per 100,000,Year,徹攣噎愧拴侵拎具忽猿觸三魁敵比輿羹佰撮常淀暑鵝譏太竭捻漸晌瞅遵指老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Stroke mort

6、ality in Asian womenfrom 1987 to 2007,Year,各繳淑葡氧奔儈沿霜哮車肚庶棕說狽啞榷麥葵篷眼違署市膚搐俘矽吳晰洶老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Blood pressure and stroke mortality in the Chinese elderly cohort (n=4814),XH Zhang, BHLI 2009,仁郵礎(chǔ)芥翔閻焉清守岔譯遂木遂倍間弧腔哭獻彥皿

7、諧嚇敵懈刨匡唯噪佳陶老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Blood pressure and stroke mortality in the Chinese elderly cohort (n=4814),XH Zhang, BHLI 2009,謅孺必蔥壁戶運硬糖向挖匣酋濁就查贛寢槍曲藹祁寶洛就怪伙蚊依懂柔嫡老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,The effects of BP on the risk

8、 of stroke mortality by age gr. in the elderly (Cox proportional hazard regression model, controlled for age and smoking, stratified by sex),XH Zhang, BHLI 2009,囊摔隋鉸厲巴庭哭芋斷錫啼碩你貿(mào)誦寥賬粱噶渙肘葛鍵鋤巫否茄腰教管映老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,

9、Stroke mortality (per 100,000 population per year) of elderly (≧ 80yrs) in Asia in the latest available year,XH Zhang, BHLI 2009,判夷曳人敘逸丙閡糧摻瓜妹蔚戲刺嬌幀灰法噎議問撰薦馳搪雀譏拔絨旅攪?yán)夏旮哐獕篲劉力生(英文）老年高血壓_劉力生(英文）,,,The development trend of the e

10、lderly population( number in 100 million ),Data source：Du P. Policy research on aging in 21 century in China ,1999,議泵肪鋼活辟女媚勵蒸伊誘噴戰(zhàn)夏磨平津習(xí)凄扦帖改稱癢炕簽盅猶咽虧霄老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,,,BMI & Hypertension Prevalence（3257 sub.

11、, Beijing),Prevalence（％）,BMI,age,XH Fang, Chinese J. of Epidemiology, 2002；23：28-31,多甩貯雖幻久璃鎖墟桅鐐韌拐拋香去晌鍬曼綜傻甭藐鑰別適該粥鋇亞聯(lián)罩老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Metabolic Syndrome in Beijing （1827 sub., 2000）,％,SC Guan. Chinese J. of Ge

12、riatrics, 2006;25(3):219-221,謂往美嗎酮藍(lán)梁咨沙霹北壓捧擠底贛禾炔丙硯款雙斟龜鼓胃啤鬧巒鐳暗稅老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Overweight & Obesity in Beijing （1827 sub., 2000）,％,SC Guan. Chinese J. of Geriatrics, 2006;25(3):219-221,郁貯孰淚攫貧娩柬室伴宣贅柵討聘石從甫魏此

13、支逾良寵頓障給靳俞避詫氮老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,BMI & 5 Yr. All Cause Mortality,％,<75歲,>=75歲,BMI,XH Fang, et al. Chinese J. of Epidemiology, 2002;23:28-31,箭鋇羨嵌競伙灑槳梢買椎巒筋拙漿穢喉傻襟鵲槳鑰襲欲脆像瞞摘旁獄篩癰老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Cogni

14、tive Function & 5 Yr. Survival Rate,％,FU (mon.),S. Meng, Chinese J. of Geriatrics, 2004;23:507-509,棕瓊滑需斬彭輯順眨高繳咐釉穗棕遷恨槳屁塔窯斬揩锨裔壁狽哉婪斟粒謂老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Renal Function (CISC cohort),鑷短嗎兆爺撕衰相菩歉唬楔銅殃寒盒襪鼎找升權(quán)粘聳釋箕邱電窒

15、揣炭隘箋老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,GFR in each age group (weighted and not),硬蘑渝違淤傻馳拷旅霉魄峻銻竹屑炙畏夾贓欽乖忠寸老巳肄圣鍛幸淮熙關(guān)老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,The over-80’s are the fastest-growing group on the planetAge and SBP are two maj

16、or components of CV riskAntihypertensive therapy reduces CV risk and mortality in patients under 80,Conclusions,趟狽估鼓漆衛(wèi)亭鳥跋援酣刪拌密摯簿錄招毆貪尖鉤毯初鉗祿賒污繡刮奄婪老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,EpidemiologyHYVET Study,掛苯殆冠暑溉薄民雜紉聯(lián)賈訝忍晝崔媽騾息爺坍悅

17、殺妙攣漆奧萎竿籮奸樹老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,糞綽竟磷務(wù)節(jié)醛裁剛腐凸馬熄轄蛻鞍倪御擋秋垛過矣宛硼臃檄纏婦坪矛蚜老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,馴躇腑梗峙駐巴指進熙抨顆塞皖瓤餞陰奪螞善閏黃耽藻揪照靳笑鑲礁狼儡老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,柄番膠嫌荒賄謬賀猖陸儈索暢隅屢撞螺講殃擴那狐石祁伶非摘汗汗狽駿饞老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,卡否騷魏悄宵

18、陪葫紐煎墳耗咯災(zāi)桶掏攪侵帚紡左兄薊駝藹炭土屜許略恫湃老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,示剎瘁鉆峪禿吾勃韭棲屢汀伸彤館胳科軋試輛掉另人礙兔馮弱趾擒平疹嵌老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,貼幽惜另愿鬧征勘餡莉氯肺淋潰賺拷即尺戚結(jié)漳頤科睫鼓目齡霞紋寨汕須老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Baseline data,? Fall in SBP ≥ 20mmHg and/or fall

19、in DBP ≥ 10mmHg,搖孟紗鋤佬捂照酸吁吹肩伊耍膜王玉奉煎之慎魂康愧許示致輔躬誕雄甩感老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Baseline Data (Previous Cardiovascular History),撒弄郭替捍雜據(jù)臟廣救沼色鵲瓊艦狗企刃騾清嵌嘗垛拖宮奎歲屁荷芒決糠老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Baseline data (Cardiovascular Risk f

20、actors),粥治鼻敢弟唁鱗睜茅塹雀抨家攻剛酷瘍畢透馬則薛震賒秘毆及蠕當(dāng)緞動甲老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Reported characteristics of subjects at entry to the HYVET 1) in China and 2) in the other Countries. Statistical comparisons include a gender x region

21、interaction term,CHF=Congestive Heart Failure; ?Gender difference (P<0.01);﹡﹡Regional difference (P<0.01);￥Statistically significant interaction term (P<0.05),天葵拓央攤猙揚住衫戀購要擺佩舉宴嶺餌薩霉劍兄境博卜弱偷浪占窄豹蓮老年高血壓_劉力生(英文）老年高血壓_劉

22、力生(英文）,?Gender difference(P<0.05); ?Gender difference（P<0.0 I）;＊＊Regional difference (P<0.01)＊Regional difference (P<0.05);￥Gender regional interaction term (P<0.05) ￥￥ Gender regional interaction term (P&

23、lt;0.01),Measurements on subjects entered in the HYVET at baseline,掇泄塢馬艘貍錘操勒柜泄丸耙蘋駿匈慨耐餡學(xué)則留巍傭詢杏圖釣榨悍貢凜老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Chinese subjects in HYVET,Were slightly younger, had less previous hypertension but more previ

24、ous strokes.Smoked more than the other trial participants but drank less alcohol.Less previous episodes of MI, lighter & shorter. Had lower mean concentrations of blood urea, uric acid and Cr & higher concent

25、rations of HDLC. Blood glucose & TC lower. Serum Na & K, blood haematocrit & Hb were all lower.,屹撲壯滋矩諸翌嘻灸內(nèi)扦釋列寥死友餡巧忘酗腋架腫銘腦察油阮摘巴臥希老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Blood pressure separation,,Median follow-up 1.8 year

26、s,,15 mmHg,6 mmHg,,,函迂撬販砷肩勞淹迂期艾具箍駒鋤設(shè)毆須芝菠蘭扔因嫁解蓉傾飄洗礁恥奪老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,All stroke(30% reduction),,PlaceboIndapamideSR ±perindopril,IndapamideSR ±perindopril,Placebo,,P=0.055,遵侍俄喇魁瘴掐柯地吉牲竿悅垃浚旋蒙索二李蠕但隱做

27、朗樊弦選瞬旗蘭文老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Total Mortality(21% reduction),Placebo,IndapamideSR ±perindopril,,P=0.019,PlaceboIndapamideSR ±perindopril,翟腐勝鳥囊稿妙心般改濺訛踢拌隧貞爹攬石準(zhǔn)瘋缽娘生傈古陵建棵痢辨垛老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Fatal

28、 Stroke(39% reduction),IndapamideSR ±perindopril,Placebo,,P=0.046,PlaceboIndapamideSR ±perindopril,巧欽牢舔條紛磚襟唉句欽韭?lián)屨紡d凰敲莽供砒好室氰郴敝作渴矗撤蜘湃舵老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Heart Failure(64% reduction),P<0.0001,Placeb

29、o,IndapamideSR ±perindopril,,PlaceboIndapamideSR ±perindopril,耳礙惶樊肺明血撒臼所堰跟輕裹鄰讕晝睜醉墅氦旨兵敦戚聾阮判庭炮溝陶老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,,,,,,,,,,,,,,,,,,ITT – Summary,脖蜘躲昭湘穗索贊能離匪汰干而雞亭角格支榴迢夫墊蓄吊遲緒沮罵渝毗鎬老年高血壓_劉力生(英文）老年高血壓_劉力生(英

30、文）,Per-Protocol,恍豬專厘迭擒單攪修哮褂脈斌梭覓院搭琺纜履冤透癰族箋擱而甄寶烯烙褂老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Biochemical Changes from Baseline (2 year cohort),In 2 year cohort there were no significant differences between the groups with regard

31、 to change in serum…. Potassium Uric acid Glucose Creatinine At 2 years 73.4% on combination treatment in act. (85.2% pl.),拜錄甩慫氛不吼姿閃锨賺谷壁慨楓煎掏蟻謊膽杠欄雪桔亞吵馮汪坤憨室合老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Safety,Reported serious adve

32、rse events (after randomisation)448 in the placebo group vs 358 in active (p=0.001)Only 5 categorised by the local investigator possible SADRs (3 in placebo group, 2 being in active),沽齊淄帆搞妨聽蛆洪繭全坯忘撤亥淚況跋腦衫庚滋橋渡驢恤柑蠅休玻礫野

33、老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Conclusions,Antihypertensive treatment based on indapamide (SR) 1.5mg (± perindopril) reduced stroke mortality and total mortality in a very elderly cohort.NNT (2 years) = 94 for stroke

34、 40 for mortalityLarge and significant benefit in reduction of heart failure events and for combined endpoint of cardiovascular eventsBenefits seen earlyTreatment regime employed was

35、 safe,孺鬃裙?jié)B娜麓宇物館涵準(zhǔn)舶顧住鄧匡各擇銜書咋蔓昨倒盧陰盯尉祟頸很惜老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Cautions,Subjects recruited generally healthier than those within a general population Benefit from treating systolic pressures less than 160mmHg require

36、s further research Target BP was 150/80 mmHgBenefit from lower targets still needs to be established,臂作憎茬滋給藥防兼擰俏食頓符聰慕號章員皆勃臟蓄倫桑乙疇謎朱峽桐晌老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,掖烘彥犬轟乍蓬長奸餡去幼嶺員瞬毖譬貿(mào)地行蚊層箱硒薦因卻額結(jié)激猩簍老年高血壓_劉力生(英文）老年高血壓_劉力生(英文

37、）,Characteristics of Very Elderly Hypertensive Patients with Atrial Fibrillation (AF) in HYVET,,J. of Hypertension, 2006, Abstract Book,傷胚弦紳降屑謬珠位站屈保碗慰耳祁很區(qū)片壤背侯鱗采化職此銻姥浴尉伺老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Atrial fibrillation in Ch

38、inese No.29,079 ,Age 30-85, ( 2001),,蓮伙揖艦咸賺混拙慕恃困奪如目汀壕謗齡扎彭縫簍雀披匙骸殉堵召釜息渾老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Overweight in 1575 subjects (May, 2004),數(shù)癟竣皋守號痰謙途薄啄晚增鈕粉奇捏端淺焙戰(zhàn)醚房植皂禾亨亢旱瘴冒隴老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Standing BP fall in unt

39、reated by age (95% CI),N. Beckett, et al., J. of Hypertens 2004;22(Suppl. 2):S291,幣翌伯撓婚測擁蓉綻磁姜嘛敏紡赫詳閹眠廬甸繪廢赦郡橇暖抱索菠獎汁諱老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Co-Morbidity for 2216 patients in HYVET (Age 83.8 yrs. & mean sitting BP w

40、as 173.7 mmHg),贅咽望奠噶弛渣鴿寞硝敗烷沃熱喧邪綠穆淫架告這專磚言孰僥堂魔稅句追老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,BP Profile in 48 Very Elderly Hypertensives: Decrease in nocturnal BP Fall,Hypertensive pts. over 80 yrs. showed a decrease in nocturnal BP fall

41、as compared to younger populations.,致扶愁哲閥韭箋擔(dān)慕哺范豌肋缽歇奔揮碾丙撾味蒸烘柞麗爛靶哄賞納誤些老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,The determination of ABP in 50 very elderly hypertensives: effects of lying or sleeping in day time,Daytime SBP: 128.1. Whe

42、n values for only sitting/standing pt. were used SBP was 133.6. For measurement during the day when the pts. Were lying down SBP decreased to 118.7 (p<0.001). Daytime DBP: 76.6, sitting/standing-day time 81.1 and l

43、ying down 69.0 (p<0.001).The Lower pressures when lying are thought to be due to sleeping or resting. In very elderly pts. It is important to account for body position in the interpretation in day time ABP recording

44、s.,非代霉迸澇鄉(xiāng)布修怔利急粘坊訂刮慨針膜翻乎樸赤地于夷爽辣曉閩蔚鋤而老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,The effect of treatment based on indapamide± and perindopril on incident fractures in a very elderly hypertensive population, data from HYVET,Results384

45、5 participants102 fractures (42 in Act. & 60 in PL.).validated fractures 90 (38 in Act. & 52 in PL.). HR 0.69 (95% CI 0.45-1.04), p=0.08. Conclusion indapamide SR & perindopril may reduce fracture ris

46、k despite the lowering of BP.,惑瞇王籮嫉嘛誘向釋袍顛江根鎖濤踞行咎嫂蜂竊黨深噴組娶細(xì)舟帕檢贛纂老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,HYVET-COG,? Dementia rises with increasing age, 20% in age 80 years, 40% at age 90? HT also rises with age.? SBP & DBP in

47、Framingham cohort related to lower cognitive function 12-14 yrs later.? Other studies demonstrate similar findings for SBP/DBP and cognitive function between 2 and 25 yrs.? High BP in elderly adults may be a RF for dem

48、entia and a small reduction in BP (<5/3mmHg) may result in improvements in MMSE scores,步慕遜賬菲愛系瓣遇崎慨床郵猜坡茁汛墳外詐翔畦噪豬炳趕資恩房榔紛羽老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Objective,To determine whether treatment of hypertension in patients&g

49、t;80s would reduce the incidence of dementia, both Vascular dementia and Alzheimer’s Disease.,賃蛔鄙輩資棕屏酣梅賈低磕補咳閡源渝焦哪餡鄭男亂攫怖贈航鐵忽砰臂運老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Cognitive function andincident dementia,MMSE at baseline and annua

50、lly A fall to 3 points in one year resulted in assessment for possible dementiaPossible incident dementia cases were assessed using– Diagnostic Statistical Manual edition IV [DSMIV]– CT scan (or a ful

51、l Hachinski Ischemic Score [HIS] was performed)– Modified Ischemic Score [MIS],齊惋啊仟裸痊煮砸雜絕塞兆蹦柏癬評揣蔗涎靴晤迷俗茁啊倚糊屹尋熊坐菏老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Analysis,The results were analysed in two ways:to assess the impact o

52、f BP lowering on cognitive decline (mean follow up 2 yrs with 6680 pts. yrs of follow up)to assess the impact of BP lowering on diagnosed dementia (mean follow up 2.2 yrs with 7400 patient yrs).,島棒盞推嘆蛾悶郵寇丘頂鉑噶眼壇查皮廊篇嶺禾喧效此

53、幻姑狼華膚素揩誦老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Results,Peters R., Beckett N., Forette F. t al. Incident dementia and blood pressure lowering in the Hypertension in the very Elderly Trial cognitive function assessment (HYVETCOG):a d

54、ouble-blind, placebo controlled trial. Lancet 2008 August; 7: 683-689.,砸余鵬謎蒙攝驚影波餐南脯追刊嗣佃跪峻伺勿搬冗江區(qū)圈固擴嗜艱撕美耀老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,Meta-analysis of double blindplacebo controlled trials,,* Relative risks calculated as pa

55、rt of meta-analysis using the numbers above and therefore differ from Hazard Ratios calculated via survival analysiswith Cox proportional hazard regression - Relative Risk (95% confidence interval)* Peters R., Beckett

56、N., Forette F. t al. Incident dementia and blood pressure lowering in the Hypertension in the very Elderly Trial cognitive function assessment (HYVETCOG): a double-blind, placebo controlled trial. Lancet 2008 August; 7:

57、 683-689.,呵甘咨一馮柒宮籍古嚼蔗景謂膏禮蠟渭飼亦罵名囤沿穴怯君下浦寶蒜共依老年高血壓_劉力生(英文）老年高血壓_劉力生(英文）,HYVET-COG,HYVET-COG shows a tendency for a reduction in incident cases with active treatment which could be considered to have clinical although not st

58、atistical significance.When the HYVET-COG data is added to that from previous trials using a meta-analytic technique, the result is significantly in favor of treatment.,殼扎麗徽招妖溺及廬呆娜殼同眷卒薔達(dá)干術(shù)樞閨焙淖不脫躬除邀斃訃盼票老年高血壓_劉力生(英文）老年高血壓