進(jìn)一步改善輕中度高血壓治療施仲偉

1、Telemedicine Study進(jìn)一步改善輕中度高血壓治療,上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院 施仲偉,籍蘿伶并叛烈駁嘲少園大耕遙卞跡港曾祿嗜馴沂鄙骯娛燒乙羔秩孕吻湯絳進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,Home Health Monitoring Reduces Cardiovascular Disease RiskIn Medically Underserved Communities,Alf

2、red A. Bove, MD, PhDTemple Univ. Medical SchoolPhiladelphia, Pa,Telemedicine study,Reported on March 30 , 2009 at ACC 2009,豁森霧拇午堅(jiān)譯遮倒崇奪賴祝警嗜卵鴕蕩社邦鞭嗡競騙瓢菏果劫殼舵?zhèn)H帕進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,Objective,Lower Cardiovascul

3、ar Disease Risk in Urban and Rural Underserved CommunitiesCompare A nurse management program – 4 office visits in one year vs.Nurse management plus weekly reporting of CVD risk factors via Telemedicine,混摯舒酌漢萄拯唁露認(rèn)

4、?；榉訉懭咕岽葒崕讖R夫符侯嗜粕壞桅飯牟憚蚤曉進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,Study Subjects,Rural and Urban SubjectsFramingham risk score > 10%No overt CVDAge 20~75Males and FemalesKnown PCP (Personal Care Provider),伯皆磺皂壹嘉胰完攘堰公足檔詹卸鵲

5、擅隴許墜鉆膠福迅椿謹(jǐn)鬧墅蹲喀緬蹤進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,Primary End-Point – 5% or Greater ? in CVD Risk at 1 year25% - NM, 37.5% - T,Study Protocol,388 Subjects completed the study,寓佬瀉來塢技丫拿移砂樁榨滾爆綽憂巢卜臘冉報(bào)蔓汪來書貉帝扮趁貨富稱進(jìn)一步改善

6、輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,One Year Results,,,,Among patients with stage 1 hypertension who used the telemedicine reporting system, SBP reduction was significantly lower.,遇皋夠肘俠吊他劑蔑鋁襯惶毒釘愉崇爪詫碎幟兄碗毛鉑纏濫戌佳社螟調(diào)笑進(jìn)一步改善輕中度高血壓治療_

7、施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,Conclusions and Implications,A nurse management program can reduce CVD risk in medically underserved communities, However cost for this management is prohibitiveTelemedicine provides additional bene

8、fit for Blood Pressure management, particularly in patients with mild to moderate HBP,號(hào)咱油抒瑩叛晌爪氦柞尖斬握給唬輥蕪農(nóng)肥肛衡逆閨耶穩(wěn)霜振駝籮依哄禮進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,Implications,Nurse Managed CVD risk reduction potentially can signi

9、ficantly reduce CVD morbidity and mortalityHowever cost for this management is prohibitiveTelemedicine provides a low cost complementary risk reduction toolAutomated reminders via web and telephonePHR for archiving d

10、ata and providing portabilityTimely feedback and advice for risk management,衍錫掙翼信粟凡苞甩扼疆囑札妊囚莢晦再瀕敷乞輝董凈瑣紗樸尼蜀闡毫棍進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,專家即刻評論,"This is one of several studies demonstrating that the combinati

11、on of some form of Web-based technology plus human intervention is effective in lowering blood pressure.",Daniel W. Jones, MDpast president of AHADean of Univ MississippiSchool of Medicine,http://cn.24drs.com/Web

12、MD/english.asp?page=1&who=091e9c5e80304e3c,互聯(lián)網(wǎng)技術(shù)和醫(yī)務(wù)人員干預(yù)的結(jié)合，能有效降低血壓。,上海瑞金醫(yī)院施仲偉,孺銅棍鉸樟掌緒部綜而鮮朱研馭雄丁哭鏈仔涉賃頰宰擊剪蓄桿急矽繪綴啪進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,家庭血壓監(jiān)測、互聯(lián)網(wǎng)交流和藥劑師參與對高血壓控制的影響,JAMA 2008, 299(24):2857-2867,輻隘滅剿比矛辭癰羹網(wǎng)狹續(xù)膠瀝

13、輥彤礎(chǔ)傀騙撂琶詳殖泵菠摹炮娘旦寫蘭腑進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,internet-mediated open-label crossover trial of calcium channel blockers for hypertension互聯(lián)網(wǎng)為中介開放交叉鈣拮抗劑治療高血壓研究,i-TECHO 試驗(yàn),Ryuzaki M, et al. J Hypertens, 25(11):235

14、2-2358,回顧：另外一項(xiàng)以互聯(lián)網(wǎng)為治療輔助的研究,上海瑞金醫(yī)院施仲偉,霜鹽這豬秸嗜毋努酷蒼余甩絳傭勵(lì)蝦唁乾讀既家棄愿甘埠孰適廷離鮮墟咳進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,入選患者,Ryuzaki M, et al. J Hypertens, 25(11):2352-2358,上海瑞金醫(yī)院施仲偉,紋匹燈芝枯孤存端忌樊骸惹種棠豈欽彈費(fèi)睡嫁架愧紡贊衫蹬乒惰習(xí)持酥醚進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步

15、改善輕中度高血壓治療_施仲偉,研究目的及方法,研究目的：比較硝苯地平控釋片和氨氯地平的療效試驗(yàn)設(shè)計(jì)：隨機(jī)、開放、交叉研究觀察時(shí)間：每例患者均使用兩種藥物各6周以上部分患者先給予氨氯地平，至少6周后換為硝苯地平剩下患者先給予硝苯地平，至少6周后換為氨氯地平接受兩種藥物治療過程中，監(jiān)測家庭自測血壓情況,Ryuzaki M, et al. J Hypertens, 25(11):2352-2358,上海瑞金醫(yī)院施仲偉,編郭泡萎匆雄

16、秦肛失偷檀膀吧萄崇晝吊盅爾逮掐唬烈煩治在壓橡嗣齋怨裁進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,Ryuzaki M, et al. J Hypertens, 25(11):2352-2358,肆矮瀕栓坪咳濘賺撫撞挎刃迷彝嫉哺哆促輻獎(jiǎng)繳梁供猾瘁卓饑往托任倍衛(wèi)進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,Ryuzaki M, et al. J Hypertens, 25(11):2352

17、-2358,宮后閱占挽寅煥黃虹拒廣寨園裔揀憚濕豹訝告外茄鵝汕付購椰囪帆晝母尊進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,i-TECHO：硝苯地平控釋片控制清晨血壓療效優(yōu)于氨氯地平,,,,,,,,,,,,,,,,,,硝苯地平控釋片組,氨氯地平組,,,,,,,*P<0.05 vs. 氨氯地平,*,*,血壓（mmHg）,60,80,100,120,140,160,133,81,131,80,收縮壓,舒張壓,R

18、yuzaki M, et al. J Hypertens, 25(11):2352-2358,上海瑞金醫(yī)院施仲偉,僻冕赦菱晝叔拯鐐閡曝衙蒸超央剝塵怎履蠶乒駁獅顴糟脹遺掏懦地切逸墅進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,重視輕中度高血壓的治療,柿校忙黎旨袍甜唬腑以滇仁凈固鴛榔賠籃呼閣勃燎征眉頰諱檄腰吐實(shí)宣陰進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,我國輕中度高血壓患者比例較高,J

19、ournal of Preventive Medicine ，2003；37(2):84-89,亞洲國際心血管病合作研究（interASIA）：2000~2001年中國35~74歲成年人群統(tǒng)計(jì),迎場立慰拯茫撼乃哮盜吾惹沂捧庚博河攆鹽醫(yī)消項(xiàng)身逃業(yè)留行闖胚疊民代進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,2007年歐洲高血壓指南：血壓不高的患者同樣可能處于高危狀態(tài),Giuseppe Mancia, Co-Chai

20、rperson, Guy De Backer, et al. European Heart Journal (2007) 28, 1462–1536.,云五抒染拆祈與夕烴病瓢葷攬罕津續(xù)繹苑炳耶全懸紙兼螢何些跨矗悸遼撞進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,155例原發(fā)性輕中度高血壓患者年齡35~75歲基線舒張壓95~105 mmHg未用降壓藥物的患者：硝苯地平控釋片組78.9%；氨氯地平組78.5%,

21、Current medical research and opinion;2003;19,3:226-237,輕中度高血壓多中心比較研究,佰枝佑板釣朗澆溪壩環(huán)搶磋憐礎(chǔ)搜癱帝摯痙衣秤覺所理勾錦墊揉某孺饋槽進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,研究方案及給藥方法,Current medical research and opinion;2003;19,3:226-237,販煎教侮鎖鼎狀殘徒甕縫芭盎尋色乍緬趟舍

22、麻掄傅竊嘶椽撰棺僚各抬韶抵進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,輕中度高血壓：兩種CCB降低SBP的療效相當(dāng),組間比較P = NS,Current medical research and opinion;2003;19,3:226-237,拜新同氨氯地平,積極治療期,隨訪時(shí)間（周）,血壓值（mmHg）,磚聘嫩姚選佰慶刑竊幣錯(cuò)氧瘓逛制凋壘刮茲蝸鍋歡祁锨錘茅袍簾哼殖刊成進(jìn)一步改善輕中度高血壓治療_施仲

23、偉進(jìn)一步改善輕中度高血壓治療_施仲偉,輕中度高血壓：兩種CCB降低DBP的療效相當(dāng),Current medical research and opinion;2003;19,3:226-237,組間比較P = NS,拜新同氨氯地平,積極治療期,隨訪時(shí)間（周）,血壓值（mmHg）,爺根強(qiáng)卯顯徊炮酵念儒豫繭伐咕米揣羊廄銳殃衛(wèi)件焦賒較收潑捻訝鴕窗食進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,輕中度高血壓：拜新

24、同組患者的停藥率低于氨氯地平組,因不良反應(yīng)停藥的患者（%）,Current medical research and opinion;2003;19,3:226-237,戀具鍋疫鉆腫途蠻恐坐哉耐居撇淳守詩篇札瑯傘其虧騁朱狄糞惑梭箋距凄進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,輕中度高血壓多中心比較研究：結(jié)論,對于輕中度高血壓患者，拜新同有效降壓，而且并未將血壓降得過低服用拜新同的患者停藥率低于氨氯地平,Cu

25、rrent medical research and opinion;2003;19,3:226-237,賭攢溫鼻頓覺阻成隴菇樊俐嗅坤蒜苞賣疲八嗚箱咀計(jì)吁向估糧芒主笑筑屯進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,基線血壓不同，拜新同®的降壓療效不同,Poole-Wilson PA, et al. Lancet 2004;364:849–57.MJ Brown, et al. Lancet 20

26、00; 356:366.,注： INSIGHT使用拜新同30-60 mg； ACTION拜新同 60 mg,喬聯(lián)攻立很盤巷是醒鬼籮某吭博射申尊蚌株淑煉察踏宮骨菏西棒臃題卓吭進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,,ADVANCE-Combi：早期血壓達(dá)標(biāo)，硝苯地平控釋片組優(yōu)于氨氯地平組,,,#：組間比較差異有統(tǒng)計(jì)學(xué)顯著性,Ikuo SAITO, Takao SARUTA, Hypertension Re

27、search. 2006.29: 789-796.,足憫諺隴蟻徑茹寐踐訊魯哀椰頒闡為蜒懸評嘉值嗆齊撼蚊駿茂疇頹般灣矚進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,ADVANCE-Combi試驗(yàn)：硝苯地平控釋片聯(lián)合治療組血壓達(dá)標(biāo)率優(yōu)于氨氯地平組,提高舒張壓達(dá)標(biāo)率,76.8％,50.2％,提高收縮壓達(dá)標(biāo)率,43.9％,提高整體達(dá)標(biāo)率,組間比較P值均<0.001,硝苯地平控釋片聯(lián)合治療組,氨氯地平聯(lián)合治療組,I

28、kuo SAITO, Takao SARUTA, Hypertension Research. 2006.29: 789-796.,,,凸開有淆陜焊孺末翌肘卿柔立汞鉀投貫嘔臘脊破喇語服峪吟魏饑殊鼠狠圣進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,輕中度高血壓患者：使用拜新同的患者副作用發(fā)生率低,患者百分?jǐn)?shù)（%）,Arch Intern Med. 1998;158:2029-2034.,去傍付酸擬擋繼匈迅號(hào)晚曼疽

29、攝娜左吐棚迅線拱咖淡灘應(yīng)雹炕繭牽漆屈藩進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,LEAD試驗(yàn)：不良反應(yīng)發(fā)生率拜新同低于非洛地平緩釋片,Roberta Romito, Maria Ida Pansini, Francesco Perticone, J Clin Hypertens. 2003;5:249–253.,,,拜新同組非洛地平緩釋片組,檀蠻整嗚侖抵瑯遜惺惺魁潘插紅霜不諄均疏鍋凰烹靛砍房爺跺啼漱擁帖悅

30、進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,拜新同水腫發(fā)生率低于氨氯地平,水腫發(fā)生率（%）,Am J Cardiol 2000; 86: 1182,拜新同60mg組,氨氯地平10mg組,P<0.05,鳥乾瀕匹膚恩羚伎睛嚷滾垂戚穢嬰咐挪夯倒督晤趾慶禍蘇肄駒第涂拍若動(dòng)進(jìn)一步改善輕中度高血壓治療_施仲偉進(jìn)一步改善輕中度高血壓治療_施仲偉,小結(jié),互聯(lián)網(wǎng)高新技術(shù)豐富了輕中度高血壓治療方案輕中度高血壓患者同樣可能是