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首页 2009年日本版高血压指南

2009年日本版高血压指南.pdf

2009年日本版高血压指南

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2011-11-12 0人阅读 举报 0 0 暂无简介

简介:本文档为《2009年日本版高血压指南pdf》,可适用于自然科学领域

GUIDELINES(JSH)ChapterEpidemiologyofhypertensionHypertensionResearch(),–doi:hrPOINTThenumberofhypertensivepeopleinJapanhasreachedapproxmillionTheaveragebloodpressurelevelsoftheJapanesedecreasedmarkedlyfollowingapeakin–ThisdecreasecloselycoincidedwiththedecreaseinmortalityrateduetostrokeinJapanMorbidityandmortalityratesduetodiseasessuchasstroke,myocardialinfarction,heartdiseaseandchronicrenaldiseaseincreasewithelevatingbloodpressureTheeffectsofhypertensionaremorespecifictostrokethantomyocardialinfarction,and,inJapan,themorbidityrateduetostrokeisstillhigherthanthatduetomyocardialinfarctionFromyoungthroughtoelderlypeople,morbidityandmortalityratesfromcardiovasculardiseaseincreasewithaincreaseinbloodpressurelevelTheriskofdevelopinganddyingfromcardiovasculardiseaseis–timeshigherinthosewithmetabolicsyndromeormultipleriskfactorsThemeansaltintakeoftheJapanesestillremainsataboutgday�,andhencethestateofahighsaltintakepersistsReducingsaltintakeisextremelyimportantforloweringbloodpressureHypertensionisuntreatedin–ofyounghypertensivepatientsbutshouldbeattemptedtobecontrolledthroughlifestylemodificationsatleastHypertensionisestimatedtobeinsufficientlymanagedinabouthalfofpatients,andthereforestrictermanagementisnecessaryIntheJapanesepopulation,ammHgdecreaseinaveragesystolicbloodpressurehasbeenestimatedtoleadtodecreasesofapproxandinthemorbidityratesduetostrokeandischemicheartdisease,respectivelyEnvironmentalimprovementstoencouragetheJapanesetoadoptbloodpressurecontrolmeasures,includingareductioninsaltintake,areawaited)MORBIDITYRATEDUETOHYPERTENSIONANDTHENUMBEROFHYPERTENSIVEPATIENTSINJAPANAccordingtothethBasicSurveyofCardiovascularDiseasesin,ofJapanesemenandofJapanesewomenagedXyearshadasystolicbloodpressureofXmmHgoradiastolicbloodpressureofXmmHg,orweretakingantihypertensivedrugs,andthetotalnumberofhypertensivepatientswasapproxmillionSimilarvalueswerealsoreportedinthequickreportoftheNationalHealthandNutritionSurveyinThenumberofhypertensiveJapaneseisexpectedtoincreasefurtherwiththegrowthintheelderlypopulation)CHANGESINAVERAGEBLOODPRESSURELEVELSOFTHEJAPANESEInJapan,withthesuccessfulmanagementofinfectionsfollowingWorldWarII,theageadjustedmortalityrateduetostrokeincreasedrapidlyandreachedapeakinItthendecreasedrapidlyuntil,andthelifeexpectancyoftheJapanesebecamethelongestintheworldDuringthisperiod,themorbidityratefromstrokedecreased,contributinggreatlytothereductioninmortalityrateduetostroke,andthedecreaseinaveragebloodpressurelevelsoftheJapaneseplayedanimportantroleinthesechangesAccordingtotheNationalHealthandNutritionSurveys,averagesystolicbloodpressurelevelsoftheJapaneseincreasedfrom,forwhichtheearliestdataareavailable,peakedataroundanddecreasedin(Figure)ThisdecreasingtendencyofbloodpressureintheJapanesehasalsobeenshownbyepidemiologicalsurveysperformedinHisayamaTown,AkitaandOsaka,)HYPERTENSIONANDTHEOCCURRENCEANDPROGNOSISOFCARDIOVASCULARDISEASEaHighincidenceofstrokeduetohypertensionThemorbidityandmortalityratesduetostrokeincreasewithaveragebloodpressurelevelsHypertensionhasahighlyspecificandcloserelationshipwithstroke,and,inJapan,themorbidityandmortalityratesduetostrokearestillhigherthanthoseofischemicheartdiseaseormyocardialinfarctionHowever,withthedecreaseinmortalityrateduetostroke,themortalityratefromallheartdiseaseshasbecomeslightlyhigherthanthatduetostrokeAccordingtotheVitalStatisticsofJapan(),theageadjustedmortalityrateduetostrokewasaboutthreetimeshigherthanthatduetoacutemyocardialinfarctionThemorbidityratefromstrokewasalsofourtimeshigherthanthatfrommyocardialinfarctioninamorbiditysurveyofOkinawaPrefecturebasedondiseaseregistrationencompassingtheentireprefectureWhentheincidenceratesofstrokeandmyocardialinfarctioninsixJapanesecohortsaged–yearsweresurveyedin–,theincidencerateduetostrokewasfoundtobe–timeshigherinmenand–timeshigherinwomenthanthatofmyocardialinfarctionStepwisepositivecorrelationshavebeenreportedbetweenhypertensionandthemorbidityandmortalityratesfromstroke–Accordingtothesubtypeofstroke,cerebralhemorrhagewasmorecloselyrelatedtobloodpressurethancerebralinfarction,butbothshowedHypertensionResearch(),–TheJapaneseSocietyofHypertensionAllrightsreserved$wwwnaturecomhrstepwisepositivecorrelationswithbloodpressureInthefollowupinvestigationoftheHisayamaStudy,astepwise,strongpositivecorrelationwasobservedbetweenbloodpressureandstroke(Figure)Furthermore,theincidenceoflacunainfarctionrevealedaclosecorrelationwiththegradesofhypertensionshownintheSixthReportoftheJointNationalCommitteeonPrevention,Detection,Evaluation,andTreatmentofHighBloodPressure(JNCVI),USAThestrongrelationshipbetweentheJNCVIbloodpressuregradesandmortalityrateduetostrokewasalsoshownclearlybyNIPPONDATA,inwhicharepresentativegroupofaboutJapanesewasfollowedupforyearsTherelativerisksofmorbidityandmortalityfromstrokeaccordingtobloodpressure,asindicatedbyfollowupstudiesinJapanandabroad,arealsopresentedasdataofHealthJapanAccordingtothesedata,anelevationofmmHginthesystolicpressureincreasesthemorbidityandmortalityratesduetostrokebyaboutinmenandaboutinwomenBloodpressureisalsorelatedtostrokeintheelderly,althoughtherelationshipisweakerthaninyoungormiddleagedpeopleTherelationshipwasclear,thoughweak,inametaanalysisintegratingmanycohortstudiesinWesterncountriesandJapanSimilarresultswerealsoobtainedintheAsiaPacificCohortStudiesCollaborationinastudysummarizingtheresultsfortheAsiaPacificregionsIntheAsiaPacificCohortStudiesCollaboration,theriskofstrokeshowsaloglinearassociationwiththenormalsystolicbloodpressurefromtheagegroupsoyearstoXyears,althoughtheassociationbecomesweakerintheelderlythanintheyoungergroup(Figure)bDevelopmentofheartdiseaseduetohypertensionTherelationshipbetweenhypertensionandheartdiseasewassimilartothatbetweenhypertensionandstroke,althoughweakerTheresultsaresimilarwhenheartdiseaseisspecifiedascoronaryheartdiseaseInmen,morbidityandmortalityratesduetocoronaryarterydiseaseincreasebyaboutwithammHgincreaseinsystolicbloodpressurecHypertensionandprognosisofchronickidneydiseasePatientswithchronickidneydiseasehaveapoorerprognosisandhigherriskofstroke,myocardialinfarctionandtotaldeathwithanincreaseinmeanbloodpressureBloodpressurecontrolalleviateskidneydisordersandreducescardiovascularriskinlaterlifeInJapanalso,cohortstudiessuchastheHisayamaStudyandNIPPONDATAhaveshownthatcardiovascularmorbidityandmortalityrisksarehigherinthosewithalowerestimatedglomerularfiltrationrate,Inaddition,NIPPONDATAindicatedthatthosewithpositiveproteinuriahaveanincreasedriskofdeathduetocardiovasculardiseaseSystolicbloodpressure(mmHg)(mmHg)WomenMenSystolicbloodpressureYearYearFigureChangesintheaveragesystolicbloodpressureoftheJapanesebysexandageReproducedfromUeshimaetalPerpersonsyearIncidence∗p<(vs<mmHg)SBP(mmHg)DBP(mmHg)<and<orororor�or�∗∗∗FigureIncidenceofstrokebybloodpressureGroupofHisayamaStudy,menandwomenagedXyearsSexandageadjusteddataofpeoplefollowedupoveryearsReproducedfromArimaetalUsualsystolicbloodpressure(mmHg)Ageatriskyears–years<yearsHazardratioandCIFigureRiskofstrokeagainstusualsystolicbloodpressurebyagegroupReproducedfromLawesetalChapterEpidemiologyofhypertensionHypertensionResearchdClusteringofrisks,metabolicsyndromeandcardiovasculardiseaseThepresenceofahighmorbidityrateduetocardiovasculardiseaseinpeoplewithmetabolicsyndromehasbeensufficientlyestablishedbyepidemiologicalstudiesinWesterncountriesInepidemiologicalstudiesinJapan,morbidityandmortalityratesfromcardiovasculardiseasewere–timeshigherinthosewithmetabolicsyndrome–TheseriskswerealsohigherinthosewithmoreriskfactorsformetabolicsyndromeMoreover,NIPPONDATAandanepidemiologicalstudyinEhimepresentedresultssuggestingtheimportanceofanaccumulationofrisksregardlessofthepresenceorabsenceofobesity,andNIPPONDATAreportedresultssuggestingtheimportanceofthepresenceorabsenceofabnormalglucosetoleranceeRelationshipofaveragebloodpressurewithcardiovascularandtotalmortalityriskatvariousagelevelsMetaanalysesthatintegratedtheresultsofmanycohortstudiesatanindividuallevelhaverevealedthatcardiovascularmorbidityandmortalityrisksincreasewithbloodpressurelevelsinallagegroups,NIPPONDATAalsoevaluatedcardiovascularmortalityriskbydividingthesubjectsintoagegroupsof–,–andXyears,andreportedthattherelativeriskwaslowerinthetwolattergroupsthanintheformergroup,butthatthecardiovascularmortalityriskincreasedwithbloodpressurecategory(Figure)Moreover,alargemetaanalysisincorporatingcohortstudiesinJapanclarifiedincreasesinthetotalmortalityratewithbloodpressurelevelforbothyoungandelderlypeople(Figure)fRelationshipofvariousbloodpressureparameterswithcardiovascularmorbidityriskAsfortherelationshipbetweenvariousbloodpressureparametersandtheriskofcardiovascularmorbidity,systolicbloodpressurehasbeenshowntofacilitatethemostaccurateprognosisandtobemorecloselyrelatedtocardiovasculardiseasethandiastolicbloodpressureorpulsepressurebyalargemetaanalysisencompassingcohortstudiesintheAsiaOceaniaregionCohortstudiesbyOyabeandOhasamaalsoreportedsimilarresults,gPrognosisofstrokeAccordingtoaWorldHealthOrganizationjointstudyonthemorbidityratesfromstrokeandmyocardialinfarction(MONICA),thecasefatalityrateinpatientswithstrokeaged–yearswithindaysofonsetwasabout,despitevariationamonggroupsOnthebasisoftheregistrationofstrokepatientsinJapanaround,theageadjustedcasefatalityrateinallpatientswithindaysofonsetwasabout,–Amongstrokesubtypes,thecasefatalityratewashighestforsubarachnoidhemorrhage,beingabout,followedbycerebralhemorrhage,about,andcerebralinfarction,aboutIntheHisayamastudybetweentheearlysandearlys,thecasefatalityratewithinyearofthefirstepisodeofstrokereachedinpatientsagedXyearsThecasefatalityratewithindayswasinmenandinwomenAccordingtotheregistrationofstrokepatientsinOyabeCity(ToyamaPrefecture),thecasefatalityratewithindaysdecreasedbyinmenandbyinwomenfromtoThepercentageofpeoplewhoneededassistanceduetoimpairedactivitiesofdailyliving(ADL)yearaftertheonsetofstrokewasabout–,indicatingtheextremeimportanceofthemanagementofhypertensionasapreventivemeasureagainststrokefromthepointofviewofthepreventionofbedriddendisability)CHARACTERISTICSOFHYPERTENSIONINTHEJAPANESEaHighsaltintakeAnexcessiveintakeofsaltwasoneofthecausesofthehighprevalenceofhypertensionandstrokeinthepastinJapanAhighsaltintakeincreasesthebloodpressureINTERSALTshowedbyanalysisofhurinecollectionthatbloodpressurewashighingroupswithahighsaltintakeandthatapositivecorrelationwaspresentbetweensaltintakeandbloodpressureinindividualsCurrently,thesaltintakeoftheJapaneseestimatedbyanalysisofhurinecollectionisapproxgday��ItislowerinwomenthaninmeninproportiontoenergyintakeAccordingtoINTERSALT,theestimatedsaltintakeinJapanesewomenintheirswasaboutgin,andaccordingtoINTERMAP,theestimatedsaltintakeinmenaged–yearsbyanalysisofhurinecollectionwasaboutginInworkingmenaged–yearssurveyedSystolicbloodpressure(mmHg)RelativeriskRelativeriskSystolicbloodpressure(mmHg)Systolicbloodpressure(mmHg)years<<>=yearsAllages�Systolicbloodpressure(mmHg)<��<�yearsFigureRelativeriskofdeathduetocardiovasculardiseasesbyageandsystolicbloodpressurelevelasindicatedbyNIPPONDATA(men,yearfollowup)ChapterEpidemiologyofhypertensionHypertensionResearchin,saltintakeestimatedbyanalysisofhurinecollectionwasaboutgAccordingtotheresultsoftheNationalHealthandNutritionSurveyin,thedailysaltintakeoftheJapanesewasapproxg(ginmenandginwomen),andhencethecurrentaveragesaltintakeoftheJapaneseisconsideredtobe–gday�Withregardtotheresultsofpastanalysesofhurinecollection,theestimatedsaltintakeintheTohokuDistrictwasashighasginthesThetargetsaltintakeproposedbyHealthJapanisogday�butnomarkeddecreasehasbeennotedduringthepastyearsaccordingtotheresultsoftheanalysisofhurinecollection,andhencethistargetremainstobeattained�SaltintakeishighinEastAsia,includingJapanParticularly,NaexcretionperunitbodyweightdeterminedbyhurinecollectionwashighinChina,KoreaandJapanamongthegroupsincountriesoftheworldsurveyedinINTERSALTAdecreaseinaveragesaltintakeaffectstheaveragebloodpressurelevelofagivenpopulationINTERSALTestimatedthatadecreaseofgday�insaltintakewouldreducetheelevationinsystolicpressurelevelafteryearsbymmHgDASH,inwhichtheeffectofthecontrolofsaltintakeonbloodpressurewasevaluated,reportedvaluessimilartothoseestimatedbyINTERSALTFurthereffortstoreducesaltintakearenecessaryforcontrollinghypertensioninJapanbChangesinthedegreeofobesityandfrequencyofmetabolicsyndromeObesityislesscommoninJapanthaninotheradvancedindustrializedcountriesHowever,bodymassindex(BMI,kgm�),whichisanindexofobesity,isfoundtoincreaseannuallyinmen,whereasitisseentodecreaseslightlyinwomenuntiltheirsRegardingthecharacteristicsofhypertensiveJapanese,leanpeoplewithaveryhighsaltintakeaccountforahighpercentage,butthenumberofobesehypertensiveshasincreasedrecently,particularlyinthemalepopulationIntheUnitedStates,BMIhasshownmarkedincreasessince,andhypertensionassociatedwithmetabolicsyndromeisgrowinginsignificanceInJapan,meanBMIisaboutkgm�,whichdiffersmarkedlyfromthatintheUnitedStates,whereitisXkgm�However,hypertensionassociatedwithobesityappearstobeincreasinginJapanesemenAccordingtotheNationalHealthandNutritionSurveyin,thepercentageofpeoplestronglysuspectedtohavemetabolicsyndromewasofmenandofwomen,andthepercentagesofthoseathighriskwereand,respectivelycUntreatedhypertensivepatientsandpoormanagementofhypertensionIfabloodpressureofXmmHgisdefinedashypertension,–ofhypertensivepatientsintheirsandsareuntreatedinJapanThesepeoplemustatleasttrytonormalizetheirbloodpressurethroughlifestylemodificationsInasurveyofmaleandfemaleworkersagedXyearsperformedatcompaniesin–,aboutwithhypertensionintheirswereuntreatedOfthehypertensivemenintheirsands,and,respectively,wereuntreatedAtthesecompanies,ahighpercentageofworkersunderwentannualhealthscreening,butthepercentageofthoseintheirsandswhorecognizedthattheywerehypertensivewasonly–TheOhasamaStudyinvestigatedthestateofbloodpressurecontrolinpatientsundergoingdepressortherapyTheresultsindicatedthatcontrolofbloodpressurewasinadequateinabouthalfofpatientsonthebasisofeithertheroutineoutpatientbloodpressureorhomebloodpressuremeasurementInaddition,inastudyofthestateoftreatmentofthoseundergoingantihypertensivetherapybyfamilydoctorsalloverJapanonthebasisofbloodpressuremeasuredathome(JHOME),homebloodpressurewasinthehypertensiverangeinapproxhalfofthehypertensivepatientsInthisstudyalso,hypertensionwaspoorlycontrolledinapproxhalfofpatients)PREVENTIVEMEASURESAGAINSTHYPERTENSIONFROMTHEPOINTOFVIEWOFPUBLICHEALTHAccordingtoNIPPONDATA,morethanhalfofthedeathsduetostrokeoccurredinpatientswithabloodpressureinamildlyhypertensiverangeorlower(systolicbloodpressureommHganddiastolicbloodpressureommHg)Therefore,itismoreimportanttopromoteareductionintheaveragebloodpressureofthegeneralpopulationthanspecificallytargetonlyhypertensivepatientsFactorsthataffectbloodpressurelevelsofthegeneralpopulationincludeage,intakesofsaltandpotassium,protein,calcium,magnesiumandfattyacids,degreeofobesity,alcoholintakeandphysicalactivitylevelWiththeexceptionofresidentsofunacculturatedareas,bloodpressureincreaseswithage,andanexcessivesaltintakeissuspectedtobeacauseofthisincreaseSaltintakeisstillhighinJapanSystolicbloodpressureisexpectedtobereducedby–mmHgthroughagdecreaseindailysaltintakeInmen,also,increasesinthedegreeofobesityareconsideredtopreventdecreasesinaveragebloodpressureAhighalcoholintakeinmiddleagedmenisalsoconsideredtobeafactorpreventingaveragebloodpressurereductionPer,personsyearPer,personsyearyearsyearsyears

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2009年日本版高血压指南

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