[Reprint] China's Guide to prevention and treatment of hypertension _ blue and white clouds

ԭ�ĵ�ַ���й��Ѫѹ����ָ�����ߣ��ľ�(2010-12-02 20:40:49)ת����ǩ����̸���ࣺ ����ָ���л����񹲺͹�����������Ѫ�ܲ������о����ĸ�Ѫѹ���ˣ��й�wbr>�й��Ѫѹ����ָ�ϣ�2005���޶��� ȫ�ģ��й��Ѫѹ����ָ���޶�ίԱ������ίԱ������������ίԱ��������wbr>�й��Ѫѹ����ָ���޶�ίԱ��ίԱ����֥�� ���� ��������(Ů)�ͱ����춦����wbr> ��������������������ά���ܱ���������Ҧ�绪���ѹ���ʸ���Ӣ�� ����wbr> �齯�۾��˳���wbr>�й��Ѫѹ����ָ��ѧ��ίԱ��ίԱ����֥�� ����wbr> ����wbr> ε���������������̹����ﺣ�뽨���������������� ����춡��׿����������wbr> ������·�춦���ͱ����������wbr> ����ɹ��������⺣Ӣ������� ����������͢����ά����һʯ���ΰ��˴ΰ��������º������Ӣ�´����ܱ�������������������Ҧ�绪���ѹ���һ�� ����������ɱ���ʹ���Ǯ����Ǯ�ݼ�˶���˸�����������ĺ��� �����������̫�������� ����wbr> �齯�۾�л�����˳�����񻪴�����κ��֮ǰ�ԡ��й��Ѫѹ����ָ�ϡ����޶��棩�ڶ�ι㷺�����ѧ��ר�����Ļ��ϣ����ҹ�20��λ��Ѫ�ܡ����ࡢ�ڷ��ڡ��񾭿ơ�������Ϊ��Ӫ�����ר����ɵ�ίԱ����ʱһ���޶���д��ɡ� Revision of this guide is based on recent advances in cardiovascular epidemiology and evidence-based medicine, taking into account the reference guide to the latest research results and recommendations of the 2003 foreign WHO/ISH hypertension treatment guide. In recent years, due to the rapid development and socio-economic change in lifestyle, incidence and risk factors of cardiovascular diseases are a growing trend. According to the 2002 national survey on nutrition and health statistics, adult prevalence of hypertension is 18.8%, have high blood pressure in patients with about 160 million nationwide. Hypertension awareness, treatment and control of rates are very low, we face a task of prevention and control of high blood pressure is very difficult. This guide from the prevalence of hypertension and prevention of reality, and people made in accordance with national conditions and control strategies of combination of high risk populations, emphasis on crowd control, at the same time strengthen the treatment of patients with hypertension. Dangers of high blood pressure among connected with patient's blood pressure level things, also depends on the presence of other cardiovascular risk factors, and combined with other disease conditions. Therefore, in the definition and classification of high blood pressure, except will set the diagnostic criteria of hypertension on systolic blood pressure �� 140mmHg and/or diastolic blood pressure �� 90mmHg; according to blood pressure is normal, normal, high blood pressure and hypertension at level 1, 2, 3, and should also be based on the combined risk factors of cardiovascular diseases, target-organ damage and at the same time with other diseases, high blood pressure patients are divided into 4 levels (groups), that is, high risk and low risk, medium risk, risk, and guide the doctor determine treatment, treatment strategies and estimate prognosis. Treatment of hypertension's main purpose is to minimize overall risk of cardiovascular morbidity and mortality. That would require doctors to treat high blood pressure at the same time, risk factors of checking out all of the reversible intervention and appropriate treatment of patients in various clinical conditions. For the average blood pressure in hypertensive patients with objective should be to 140/90mmHg, and for diabetes patients, blood pressure should be reduced to below 130/80mmHg. In the initial drug of choice, primarily on the basis of personal circumstances, combined with social and economic issues, according to our current situation, groups should be treated as generic cheap anti-hypertensive drugs is recommended in patients with hypertension, first of all to improve treatment and on this basis, gradually increase the control rate. Clinicians can choose according to patient condition, b blockers, calcium antagonists diuretics, angiotensin converting enzyme inhibitor (ACEI) or Angiotensin II receptor (AT1) antagonist (ARB) or more, or fixed-dose effects of hypotensive preparations made from these drugs. Blood pressure targets, most patients with hypertension requires two or more antihypertensive combination. 2004���й��Ѫѹ����ָ��Ҫ��:Ҫ��1ָ�ϵ��޶���ǿ����Ҫ��llWBR> is a growing trend of the prevalence of hypertension in China, it is estimated that there are 160 million patients with high blood pressure, hypertension awareness, treatment and control of the lower. ll���Ƹ�Ѫѹ��Ԥ����Ѫ�ܲ�����Ҫ��ʩ�� Stroke is a threat to the health of our people's major diseases, controlling high blood pressure is the key to preventing stroke. ll����Ŀ����ͨ��ѹ����ʹ��Ѫѹ���ߵ�Ѫѹ��꣬��������޶ȵؽ�����Ѫ�ܷ�������������Σ�ա� ll���Σ�շֲ㣬ȷ�����Ʒ���llѪѹ��110/75mmHg����ȺѪѹˮƽ�������Ѫ�ܲ�Σ�ճ�����������ء� ll���ֵѪѹ��120~139/80~89mmHg���ߣ�Ӧ������ʽ��Ԥ����Ѫѹ����Ѫ�ܲ��ķ��� ll��ѹĿ�꣺��ͨ��Ѫѹ���ߵ�Ѫѹ����140/90mmHg���£������˵�����ѹ����150mmHg���£������򲡻������ĸ�Ѫѹ���ߵ�Ѫѹ����130/80mmHg���¡� ll�������b���ͼ���ACEI�����׿�����ARB���ͼ��������Ƽ������Ϊ��ѹ���Ƶ���ʼҩ��ά��ҩ����ݻ��߾������ѡ����ҩ�� ll������Ѫѹ������Ҫ2�ֻ�2����Buck on prescription to reach target blood pressure. stresses the importance of improvement of life style on the prevention and treatment of high blood pressure is not only beneficial in patients with high blood pressure, high normal blood pressure values and to people is also good. On the control of special populations, including hypertension, pregnancy-induced hypertension in the elderly, as well as at the same time suffering from cerebrovascular diseases, diabetes, coronary heart disease, heart failure or kidney disease in patients with hypertension, the Guide has its own discussion. Hypertension prevention and control must be taken to the whole population, prevention and treatment of patients with high-risk populations and combination strategies, controlling risk factors, early diagnosis and early treatment and standardized management of patients start with three links, constructing the full front of hypertension prevention and control. Efforts to raise awareness, treatment and control of hypertension. These goals must depend on the transfer of the change of the ideas and strategies. From disease-led, turning health-led. From a patient-centered, turned to the crowd as the Center, will work in the Centre of gravity moves forward, and generally raise the level of health awareness and health of the population. From focus on medical, shifted to focus on preventive health care, comprehensive control of various risk factors. From specialist-dominated, turned to general practitioners, nurses, health care, laboratory, public health personnel to participate in team management. From the University Hospital-centric, shift to community-centered, high blood pressure prevention and treatment policies, measures, outcomes and experiences into communities of practice. From the health sector and towards social participation, and give full play to the various government departments, professional bodies, enterprises, the media and the role of the community, establishing a wide range of prevention and treatment of hypertension League and United Front. Revision of the guidelines for the prevention and treatment of hypertension in China for our 21st century prevention of high blood pressure and a clear direction for clinical practice. Guide to principles into action requires government departments, academia, as well as a full range of support in the community, control of front line staff seriously implemented, serving the majority of urban and rural residents, for the prevention and treatment of hypertension in China make a contribution to a new level. in 2004, China's prevention and treatment of hypertension guidelines Revision Committee under China's recent progress in cardiovascular epidemiology and evidence-based medicine, refer to the latest research reports and guides at home and abroad, to revise the 1999 guidelines for the prevention and treatment of hypertension in China. First draft published before the end of 2004 (practical), repeatedly sought views on the basis of 2005 full-text publication. 1. the prevalence of hypertension high blood pressure is an ancient disease, more than 100 years ago, after the Riva-Rocci invented the cuff blood pressure monitor medical understanding of the physiological and pathological significance of hypertension. 20th century a large number of population distribution of blood pressure and blood pressure and cardiovascular disease epidemiology and clinical research, confirms high blood pressure is caused by a major risk factor for cardiovascular disease. Epidemiological characteristics of hypertension research, the first problem to be solved is the diagnostic criteria of hypertension determined. Blood pressure distribution close to the normal distribution of the crowd. How to determine the boundaries of hypertension and Normotensive points (cutoffpoint) has been the focus of hypertension study on the epidemic. In theory, determination of the demarcation point is artificial, but from a clinical point of view, this point should be able to distinguish between "sick" and "no" sweet spot. The normal physiological indicators and identify any normal distribution, the principle is the same. After years of observation, research and feasibility studies, now comparing the same views are 140mmHg and systolic blood pressure DBP 90mmHg is best able to (sensitivity and specificity of the best) predicting the demarcation point of high blood pressure as a result of cardiovascular disease. However, is systolic blood pressure or diastolic blood pressure, each has a different opinion. As the systolic blood pressure measurement (according to Korthof tone first tone) more accurate, so initially systolic blood pressure is recommended. Later study found greater clinical significance of diastolic blood pressure, diastolic blood pressure is recommended. Also mean blood pressure and pulse pressure in recent years the importance of a wide range of research, but the results show that this two kinds of indicator unsuitable as a distinction between "high" and "normal" targets. After years of debate and research, is now more consistent advice is both systolic and diastolic blood pressure two indicators. Therefore, "systolic blood pressure �� 140mmHg and/or diastolic blood pressure �� 90 mmHg" is internationally accepted standards for the diagnosis of high blood pressure. In determining the diagnostic criteria of hypertension at the same time, also on international measurement of blood pressure measurement methods, instrumentation, environment, and factors influencing the frequency of a clear provision, formed a standardized method for measuring blood pressure, Hypertension epidemiology and the international community played an important role in promoting. 1.1 General Law of hypertension prevalence after years of epidemiological studies, now on the prevalence of hypertension in the crowd character and a clearer understanding of law. Hypertension prevalence of the general rule is: (1) the prevalence of hypertension is proportional to the age, and (2) prior to menopause incidence than men, than men after menopause; and (3) geographical distribution. General rule is to high latitudes (cold) higher than the low-latitude (warm) areas. High altitudes higher than lower elevations; (4) there are seasonal differences in the same population, prevalence rates in winter than in summer, and (5), and eating habits. Per capita salt and saturated fat intake, the higher the higher the average blood pressure levels. Often a large number of drinkers blood pressure levels higher than those who do not drink, or drink less; (6) showing is positively correlated with the level of economic and cultural development. Economic and cultural backwardness is not "civilized" areas seldom have high blood pressure, economically and culturally more developed, per capita higher the blood pressure levels; and (7) the prevalence of human obesity and stressIs positive, showing negative correlation with the level of physical activity, and (8) the genetic basis of hypertension has some. Immediate family members (especially between parents and their own children) blood pressure significantly. Blood pressure between different racial and ethnic groups with certain differences. 1.2 changes in the prevalence of hypertension and its trends have been three large-scale hypertensive population sample. 1958-1959 the first survey (municipal), investigated a total of about 500,000 population over the age of 15. Around the time of diagnostic criteria are inconsistent, together with statistical techniques behind, it failed to get the exact prevalence data. Roughly calculated average prevalence rough of 5.1%. 1979-1980 the second national survey, total search among people over the age of 15 is about more than 4 million. At the time of the World Health Organization standards (�� 160/95mmHg diagnosed hypertension, 140/90mmHg and 160/95mmHg of borderline hypertension). Then misunderstood, not people diagnosed with high blood pressure blood pressure value is one hundred and forty-ninetieths. In accordance with prevailing standards (systolic diastolic blood pressure �� or �� 141mmHg/91mmHg), with a total of borderline hypertension above rough 7.73%. In 1991 the third national survey, total search among people over the age of 15 more than 900,000. Full at the time of the international standards (systolic diastolic blood pressure �� or �� 140mmHg/90 mmHg or two weeks taking antihypertensive drugs), the resulting total prevalence of rough of 13.58%. According to standards adopted by the second survey (systolic or diastolic blood pressure �� �� 141mmHg/91 mmHg), sick rough as 11.88%. Thus, due to historical reasons, is unlikely to be based on results of the third survey to accurately estimate the trend of the prevalence of hypertension. But these data clearly reflected the upward trend of the prevalence of hypertension in China. In particular the second and third survey, using a blood pressure measurement methods and the same age group. In using the same standard (second survey of the standard) is fully comparable data. Results showed that 10 years from 1980 to 1991, a 4.15% increase in the prevalence of hypertension, a 54% increase in absolute value. epidemiology in Chinese population survey shows that stroke is a major threat to human health disorders. Research suggests about two hundred and fifty-tenths people stroke incidence, incidence of coronary heart disease is about fifty-tenths people. Stroke incidence is coronary heart disease by 5 times. Therefore, focuses on the prevention of stroke prevention and treatment of cardiovascular disease. The major risk factors for stroke are hypertension, actively controlling high blood pressure are important measures for prevention of stroke. blood pressure levels in Chinese population start at 110/75mmHg, with elevated levels of blood pressure and cardiovascular disease risk continued to increase, compared with blood pressure <110/75mmHg blood pressure when 120~129/80~84mmHg, increased cardiovascular risk 1 time and 140~149/90~94mmHg of blood pressure, cardiovascular disease risk increased twice, when blood pressure >180/110mmHg, cardiovascular disease risk increased 10 times. in recent years, due to changes in social change and people's lifestyles, incidence and risk factors of cardiovascular diseases in China there is an increasing trend. According to Ministry of health in 2002 organized by the residents of 270,000 human nutrition and health status information shows that dietary quality improved significantly in China, but city residents ' dietary patterns are reasonable. Livestock and grease consumption is too large, rapidly increased prevalence of chronic non-communicable diseases. Chinese residents aged 18 and over with hypertension prevalence of 18.8%, it is estimated that number more than 160 million nationwide. Compared with 1991, prevalence increased by 31%. Hypertension awareness in China of 30.2%, treatment of 24.7%, control rate of 6.1% per cent, compared with the 1991 has increased, but is still in a poor standard. Prevalence of diabetes among residents aged 18 and over to 2.6%, impaired fasting glucose is 1.9%. Estimated number of national prevalence of diabetes more than 20 million, with nearly 20 million of impaired fasting glucose. Compared with 1996, big city over 20 years of diabetes prevalence rose from 4.6% to cent, an increase of 39%. Adult prevalence rate of Dyslipidemia 18.6%, estimated number of national prevalence Dyslipidemia 160 million, including hypercholesterolemia 2.9%, high blood triglycerides 11.9%, low density lipoprotein in patients with 7.4%. Adult overweight rate of 22.8% obesity rates is 7.1%, estimated national number 200 million overweight, fat people in more than 60 million. Childhood obesity rates have reached 8%, should be taken seriously. Compared with 1992, increase in adult overweight 39% obesity rates rise in 97%. Surveys have shown that diets high energy, high in fat and less physical activity and the occurrence of overweight, obesity, diabetes and Dyslipidemia are closely related, high-salt diet linked to hypertension, alcohol consumption and the prevalence of hypertension and Dyslipidemia are closely related, less fat intake and physical activity more people, more chances of suffering from this chronic disease. 1.3 high blood pressure in patients with hypertension awareness, treatment and control of hypertension awareness, treatment and control are important parameters of the epidemiology and control of hypertension. In 1991 the national sample was collected blood pressure hypertension awareness, treatment and control of the number of(1991, table 1, information from the Chinese Journal of hypertension in 1995 supplements, 17 pages). ��11991�� 2002���ҹ���Ⱥ��Ѫѹ����֪���ʡ������ʺͿ�������Ѫѹ����֪����*��%����ҩ��*��%��������*��%��1991�꣺������Ů�ϼ�37820357527357232.139.435.614.719.717.13.34.94.1ũ��wbr>��Ů�ϼ�26816286515546711.715.913.94.46.45.41.01.41.2�ܼ�12903926.312.12.82002�꣺�ܼ�2980030.224.76.1*2002��Ķ��壺֪����Ϊ�ɱ����Ϊ��Ѫѹ�ĵ�������ڵ���ǰ��֪���Լ����и�Ѫѹ�ߵı���������Ϊ�ɱ����Ϊ��Ѫѹ�ĵ�������н�2���ڷ���ѹҩ�ߵı��������Ϊ�ɱ����Ϊ��Ѫѹ�ĵ��������Ŀǰͨ������Ѫѹ��140/90mmHg�����ߵı��� data in table 1 suggest that current prevalence of hypertension in patients with essential hypertension awareness, treatment (medication) and control rates are very low. In addition, the corresponding rates significantly lower than in the countryside cities, males than females. United States in the 1980 of the 20th century, statistics showed that awareness of 60% in patients with hypertension, medication is 40%, controlling the rate of 25%; more than 2000 years three rate up to 70%, and 59%. more than epidemiological data show that nearly half a century in Chinese population prevalence of hypertension increased rapidly. Other studies also show that, other risk factors for cardiovascular disease (Dyslipidemia, obesity, diabetes, smoking, and so on) is clearly on an upward trend, accelerated hypertension pathogenic processes. Lead to high blood pressure and other risk factors increased mainly due to China's economic development, living standards improve and speed up the pace of life brought about by a series of due to unhealthy lifestyles. One of the most important dietary imbalances, smoking and excessive alcohol consumption, lack of physical activity and mental pressures increase. These adverse trends, as well as very low prevalence of hypertension control rates, is a serious challenge to the prevention and treatment of hypertension in China as well as an opportunity. Every medical personnel on the prevalence of hypertension and its results in China must have a clear understanding of the consequences, maintain a high degree of vigilance and to take strong measures to prevent it. 1.4 become Chinese first death of cardiovascular and cerebrovascular disease, risk factors for high blood pressure is the first recent 170,000 people in China should be more than 40 years old for 8 years (123 people-years) follow-up results indicate that total deaths 20,033, overall mortality rate of 1345.2 per 100,000 person-years. Top three causes of death (mortality per 100,000 person-years), heart disease, respectively (296.3), cancer (293.3), cerebrovascular disease (276.9). Total death risk factors in the first place is hypertension (relative risk: RR=1.48), smoking (RR=1.23) and the lack of physical activity (RR=1.20). Heart disease accounted for 23.1% of the total deaths, cancer, 22.3%, cerebrovascular disease accounted for 21.3%. Death of cardiovascular and cerebrovascular disease with total 44.4%. Hypertension and related disease burden is immense, according to the 2003 hypertension in direct medical costs for30 billion yuan, cerebral vascular disease is $ 26.3 billion, heart of $ 28.8 billion. Estimated annual cost of cardiovascular and cerebrovascular disease (direct medical costs and indirect costs) 300 billion yuan. 2. blood pressure and cardiovascular disease risk incidence of continuous blood pressure and cardiovascular disease are related. Many related diseases and hypertension occurs in normally is considered to be "normal" users, therefore, high blood pressure in patients with cardiovascular disease risk depends not only on blood pressure levels, also depends on both the number and extent of other cardiovascular risk factors. 2.1 internationally recognized risk factors for hypertension are risk factors for hypertension: overweight, more than high-salt diet and moderate drinking. Epidemiological studies have confirmed that the three major factors associated with the incidence of high blood pressure significantly, but also has its own characteristics. 2.1.1 of abdominal obesity or overweight and obesity in China in normal adult body mass index (BMI:kg/m2) for 19~24, body mass index �� 24 overweight, should be more than 28 per cent for obesity. Differences in body mass index on population prevalence rate has a significant impact on blood pressure and hypertension. Blood pressure and hypertension in Chinese population prevalence is higher than in the North the South, parallel with the differences in body mass index. Baseline body mass index for each additional 3, and 4 years within the risk of hypertension in women 57%, men 50%. Of abdominal obesity: Chinese adults "metabolic syndrome" waist tangential point of research has shown that middle age as waist circumference increased, "metabolic syndrome" component aggregation OR a marked rise; abdominal fat accumulation and increased risk factors are closely related. Male-female waist circumference �� 85cm, �� 80cm as tangent points, check out the "metabolic syndrome" of false positive and false negative rates are relatively low. 240,000 adult data meta-analysis showed that BMI �� 24kg/M2 3~4 the risk of high blood pressure is normal weight, diabetes risk is 2~3 times the normal body weight, with 2 and 2 or more risk factors for hypertension and diabetes risk is 3~4 times the normal weight. BMI �� 28kg/M2 over 90% of obese patients suffering from these diseases or risk factors for aggregation. Male waist circumference �� 85cm, hypertension risk for female �� 80cm waist circumference less than 3.5 times the boundaries, its prevalence is 2.5 times the risk of urinary diseases, of which 2 and aggregation of 2 or more risk factors for hypertension and diabetes risk for more than 4 times the normal weight. recently, the International Diabetes Federation announced the "metabolic syndrome" standards for abdominal obesity is a Chinese waist circumference �� 90cm male and female �� 80cm. Waist size now loose minute jackets used was about abdominal obesity obesity working group proposed standards in China, but in different studies may also refer to the standards of the International Diabetes Federation. Waist size standards related to abdominal obesity in China still needs further study. ��2�й���˳��غͷ��ֵ�����ָ�����Χ����ֵ����ؼ���*Σ�յĹ�ϵ��������ָ��(BMI)��kg/m2����(cm)�У�<8585-94��95Ů��<8080-89��90���ع�**<18.5������������18.5-23.9�����Ӹ߳���24.0-27.9���Ӹ߼��߷��֡�28�߼��߼���*��ؼ���ָ��Ѫѹ�����򲡣�Ѫ֬�쳣��Σ�����ؾۼ��� **���ع�Ϳ���Ԥʾ���������⣨�й���ֹ����飬�л����в�ѧ��־2002��23�ڣ�ע��Ϊ��������ݿɱȣ��ڽ�BMI���ͳ��ʱ��Ӧ����BMI��25����30���� In order to fully evaluate, you can also calculate waist circumference of male and female �� �� 95cm 90cm data. 2.1.2 drinking alcohol at least once a week for the calculation of drinking, middle-aged men drinking rate 30%~66% females are 2%~7%. Male drinkers than those who do not drink 4 years at increased risk of hypertension 40%. 2.1.3 salt-sodium diets high in Chinese population salt intake is higher than in Western countries. Population salt intake by around 12g-18g per person per day in the North, South of 7g-8g. Correlation between dietary sodium intake and blood pressure significantly, crowd blood pressure levels in the North than the South. After the control of total calories, dietary sodium and the systolic pressure and the pressure of the correlation coefficient up to 0.63 and 0.58 respectively. Population increase in average daily intake of salt 2G, systolic and diastolic blood pressure rise in 2.0mmHg and 1.2mmHg respectively. 2.2 blood pressure is a risk factor for cardiovascular disease blood pressure are strokeIndependent risk factors and coronary heart disease. 2.2.1 elevation of blood pressure is the most important group of Chinese stroke risk factors for stroke in high risk countries, 1997, Beijing 35~64sui WHO-MONICA study two hundred and forty seven-tenths million for the incidence of stroke in men, and women of one hundred and seventy five-tenths people. 10 groups of population studies have shown that blood pressure and stroke risk log-linear relations, baseline rise in systolic blood pressure every 10mmHg, 49% increase in relative risk of stroke (47% increase in ischemic stroke, hemorrhagic stroke increase 54%); diastolic blood pressure rises 5mmHg, increased risk of stroke 46%. East Asian population analysis shows that China and Japan crowd, elevated blood pressure effect on the incidence of stroke intensity to Western crowd 1.5 times. Study suggests older basis and in the long-term treatment of patients with cerebrovascular disease mean systolic blood pressure levels associated with recurrent stroke. Stroke prevention study in seven Chinese cities showed that blood pressure levels linked to stroke risk, rise in systolic blood pressure every 10mmHg, stroke risk increases by 25%. Community intervention treatment can bring down the danger of stroke 31%. 2.2.2 elevation of blood pressure is elevated blood pressure of the Chinese group of risk factors for coronary heart disease is an independent risk factors for coronary heart disease in the West, Framingham Heart study and MRFIT study has confirmed. Shougang company risk factors for coronary heart disease in men: a prospective study shows that when the systolic blood pressure 120~139mmHg, relative risk of coronary heart disease increased by 1.3 times times higher than <120mmHg 40%,140~149mmHg, also shows blood pressure effects on coronary heart disease in the Chinese population. A rapid rise in blood pressure induced by acute myocardial infarction. 2.2.3 blood pressure increases the risk of heart failure and kidney disease have a history of congestive heart failure risk of hypertension than persons without a history of high blood pressure high 6 times. Diastolic blood pressure lowering 5mmHg, makes the risk of end-stage renal disease with one-fourth. According to Chinese cardiovascular health study, prevalence of heart failure is 0.9%, it is estimated that there are 4 million patients with heart failure. 2.2.4 pulse pressure effect on cardiovascular disease in the elderly. Pulse pressure increase is a reflection of poor arterial elasticity index. Syst-China, Syst-Eur and EWPHE of hypertension in the elderly, such as test summary analysis showed that the baseline pulse pressure and total mortality in the elderly over 60 years, cardiovascular death, stroke and coronary heart disease is a significant positive correlation. Study suggests older pulse pressure in patients with cerebrovascular disease associated with recurrent stroke. 2.3 other risk factors for cardiovascular disease cardiovascular disease is the result of combined effects of multiple risk factors, at the rise of several risk factors on the absolute risk of cardiovascular disease may exceed the height of individual risk factors increase the dangers posed by. We have when considering treatment approaches and hypertensive patients, not only the basis of their blood pressure, you should also consider other risk factors. Other risk factors for cardiovascular disease are as follows: 2.3.1 age: cardiovascular disease increase with age. Beijing 35-74 residents, age 10 years of growth, increased incidence of coronary heart disease 1~3 times, increase in incidence of stroke in 1~4 times. This is because most of the rise in risk factor levels increase with age, although older high speed has slowed, but because of the high incidence in the elderly, the absolute risk is still very high. 2.3.2 sex: cardiovascular morbidity in men than women, 14 people monitoring according to the results for 5 years in China, 25~74sui male patients with coronary heart disease, stroke incidence in women's 1.1~6.2 and 1.2~3.1, respectively. 2.3.3 smoking: smoking is recognized as an important risk factor for cardiovascular disease. 10 groups of prospective study cohort showed that higher relative risk of coronary heart disease than nonsmokers smokers twice times, increased risk for ischemic stroke 1 time, elevated cancer risk 45%, aggregate mortality risk increased 21%. Beijing information indicates that smoking amount for each additional 1 time, increased by 4 times times the risk of acute myocardial infarction. 2.3.4 Dyslipidemia: serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) elevated is a risk factor for coronary heart disease and ischemic stroke. Shougang male blood TC200~239mg/dl, twice the risk for coronary heart disease TC<200mg/dl times, 3 times the risk for >240mg/DL <200mg/DL. Shanghai, a group of employees data also show that, although TC blood levels lower than the Western, but their relative risk of death is still log-linear relationship between coronary heart disease. Explains blood TC as a risk factor for coronary heart disease, there is no minimum threshold. The other hand, also has information on TC tips such as blood is too low (<140mg/DL), it is possible to increase the risk of hemorrhagic stroke. 14 groups of population studies have shown that high density lipoprotein cholesterol in populations (HDL-C) are associated with coronary heart disease incidence was significantly negative. 2.3.5 of overweight and obesity: overweight and obesity is a risk factor for hypertension, as well as independent risk factors for coronary heart disease and stroke. Body mass index (BMI) level is less than the West, but the faster-growing in recent years. BMI levels linked to cardiovascular disease in Chinese population. At baseline BMI for each additional 1kg/m2, increased risk of coronary heart disease 12%, increased risk of ischemic stroke in 6%. Overweight and obesity is coronary heart disease tips and independent risk factor for ischemic stroke. 2.3.6 diabetes and insulin resistance: diabetes mellitus is a clear risk factors for atherosclerotic disease, coronary heart disease CHD risk equivalents. According to a 1994 survey of more than 200,000 people, my diabetes prevalence and impaired glucose tolerance prevalence and 2.5%, respectively, than they were 10 years ago grew 3 times. 2002 survey also hints big city over 20 years of prevalence of diabetes than per cent from 1996. Diabetes mellitus in patients with BMI, waist, and blood pressure levels are higher than non-diabetic persons. Our data also shows that serum insulin level and many risk factors for cardiovascular disease significantly related to, such as high triglycerides and low HDL-C, overweight and obesity, high blood pressure, high cholesterol and uric acid and so on. Study data show that diabetes group Daqing coronary heart disease is the number 10 times more than double the normal glucose tolerance. Postprandial blood glucose levels and coronary heart disease are related. 2.3.7 c-reactive protein: many studies have shown that c-reactive protein and cardiovascular disease-related, predictable occurrence of cardiovascular events, as strong as its ability to predict and LDL-C. C-reactive protein and "metabolic syndrome" are closely related. Required further accumulation of domestic research data. 2.3.8ȱ����������������������ɳ���/���ֵ���Ҫԭ��֮һ�� Follow-up studies show that the rural farmers in Beijing and Guangzhou, turning township enterprises when workers or farmers in non-agricultural workers and field workers, significant increases in BMI, other cardiovascular risk factors is significantly increased. Lack of physical activity can increase cardiovascular disease risk in patients with hypertension. 2.3.9 history of cardiovascular disease: the history of the disease: a family history of cardiovascular disease, I have patients with cardiovascular illness (such as stroke, myocardial infarction, heart failure, and so on) or a history of kidney disease, and may increase the risk of cardiovascular disease. 3����������������������棺�� ȷ��Ѫѹˮƽ��������Ѫ�ܲ�Σ�������� �жϸ�Ѫѹ��ԭ����ȷ���޼̷��Ը�Ѫѹ���� Ѱ�Ұ��������Լ�����ٴ������wbr>Ŀ�������ڸ�Ѫѹԭ��ļ����ϡ���Ѫ��Σ�����ص���������ָ����ϴ�ʩ��Ԥ���жϡ� In patients with the information you need from family history, medical history, physical examination and laboratory tests. 3.1 clinical history and family history Essentials 2 clinical history and family history collection 1. 1.����Ѫѹˮƽ����Ѫѹ����2. 2.�̷��Ը�Ѫѹ��ָ��ll���༲������ʷ��������ll���༲������·��Ⱦ��Ѫ������ֹʹҩ����ʵ���Լ�����llҩ��ڷ�����ҩ���ʲݡ���θͪ���α�ҩ���ɿ��򡢰�����������̴����������࿹��ҩ���ٺ�ϸ�����ء����߾�lwbr>l���Գ�����ͷʹ�����ǡ��ļ£��ȸ�ϸ����ll���Լ������;��Σ�ȩ��ͪ����֢��3. 3.Σ����ll��Ѫѹ����Ѫ�ܼ����ĸ���ʷ�����ʷllѪ֬�쳣�ĸ���ʷ�����ʷll���򲡵ĸ���ʷ�����ʷll����ϰ��ll��ʳϰ��ll���֣����ll4. 4.������֢״ll�Ժ��ۣ�ͷʹ��ѣ�Ρ������½�����������ȱѪ�������о����˶�ȱʧll���ࣺ�ļ¡���ʹ����̡��ײ�ˮ��ll�����ڿʡ�����ҹ��Ѫ��ll����Ѫ�ܣ�֫�˷��䡢��Ъ������5. 5.����ѹ����ll����ҩ�Ｐ����Ч�͸���6. 6.���ˡ���ͥ�ͻ�������ȫ��IJ�ʷ�ɼ���Ϊ��Ҫ��Ӧ��ll����ʷ��ѯ�ʻ������޸�Ѫѹ�����򲡡�Ѫ֬�쳣�����IJ��������л����ಡ�ļ���ʷ��llr />���̣�����Ѫѹ��ʱ�䡢Ѫѹˮƽ���Ƿ���ܹ��Ѫѹ���Ƽ�����Ч�͸����ã�ll֢״������ʷ��Ŀǰ���������޹��IJ�������˥�ߡ���Ѫ�ܲ�������Ѫ�ܲ������򲡡�ʹ�硢Ѫ֬�쳣��֧��ܾ��Ρ�˯�ߺ�����ͣ�ۺ�֢���Թ����쳣�����༲���ȵ�֢״��ʷ�����������ll������ʾ�̷��Ը�Ѫѹ��֢״��ll��ʽ����ϸ�˽���ʳ�е�֬�����Ρ���������������֧�����������ѯ�ʳ���������������llҩ���¸�Ѫѹ����ϸѯ�������ÿ������Ѫѹ��ҩ���ڷ�����ҩ���������࿹��ҩ���ʲݵȣ�ll����������أ���ϸ�˽����Ӱ���Ѫѹ���̼���Ч�ĸ���������ͻ������أ�������ͥ����������������Ļ��̶ȡ� 3.2 physical examination: a careful physical examination will help find clues to hypertension and secondary target-organ damage. Include a correct measurement of blood pressure of limbs, measurement of body mass index (BMI), measure waist circumference or waist, checking eyes, observing the Cushing-free face, neurofibroma skin spots, exophthalmos, lower extremity edema symptoms of hyperthyroidism, auscultation, chest, abdominal aorta artery in carotid artery, femoral artery with or without noise, palpation of the thyroid, full of heart and lung checks, check abdomen expanded with and without kidney, tumors, extremity arterial pulsation, examination of the nervous system. 3.3ʵ���Ҽ�飺Ҫ��3ʵ���Ҽ�鳣����llѪ�ǣ��ո�Ϊ�ˣ�llѪ���ܵ��̴�lr />lѪ����ܶ�֬���׵��̴���HDL-C��ll�ո�Ѫ�������llѪ����llѪ�弡�llѪ���llѪ�쵰�׼���ϸ�����ll��Һ����ll�ĵ�ͼ�Ƽ��ļ��ll�����Ķ�ͼll���������͹ɶ���������llC����Ӧ����ll��΢���׵��ף����򲡲��˵ıز���Ŀ��ll�򵰰׶���������ά��ֽ���Ϊ���ԣ�ll�۵׾���飨���ظ�Ѫѹ�ߣ�ll��Ƭ��һ����飨רҵ���룩ll�кϲ�֢�ĸ�Ѫѹ���Թ��ܡ��Ĺ��ܺ������ܼ��ll�̷��Ը�Ѫѹ���ⶨ���ء�ȩ��ͪ��Ƥ�ʼ��غͶ��Ӱ�ˮƽ��������Ӱ�����������ٳ������������CT����ͷ���Ź�����񳣹��飺llѪ���ء��ո�Ѫ�ǡ�Ѫ���ܵ��̴����������������ܶ�֬���׵��̴������ܶ�֬���׵��̴������ᡢ����llȫѪϸ�����Ѫ�쵰�׺�Ѫϸ�����lr>l��Һ�������򵰰ס��Ǻ������죩ll�ĵ�ͼll���򲡺�������������Ӧÿ�����ٲ�һ���򵰰ס� recommended inspection items: Echocardiogram, carotid and femoral artery ultrasound, postprandial blood glucose (measurement when the fasting plasma glucose �� 6.1mmol/or 110mg/d), c-reactive protein (high sensitivity), and Microalbuminuria (diabetic patients will find items), urinary protein quantitation (cellulose paper check as a positive check this item), fundus examination and chest, sleep apnea monitoring (sleep apnea syndrome). suspected and secondary hypertension, respectively, check the following as needed:, blood plasma Renin activity and aldosterone in urine, blood and urinary catecholamine, angiography, kidney and adrenal gland ultrasound, CT or MRI. 3.4Ѫѹ������Ѫѹ��������ϸ�Ѫѹ�����������س̶ȵ���Ҫ�ֶΣ�Ŀǰ��Ҫ���������ַ�����3.4.1����Ѫѹ����Ѫѹ��Ŀǰ�ٴ���ϸ�Ѫѹ�ͷּ��ı�׼��������ҽ����Ա�ڱ�׼�����°�ͳһ�Ĺ淶��Ҫ��4Ѫѹ�����IJ���ll����Ҫ�������ڰ����ķ����5���Ӻ��ٿ�ʼ������ ll���ٲ������Σ����1~2���ӣ������β���������Ƚϴ�Ӧ�ٴβ����� ll���ñ�׼���12-13cm����35cm����������ϱ۽ϴֻ��ϸʱ��Ӧ�ֱ���ýϴ���С������ͯӦ���ý�С����� llRegardless of the positions patients, upper arm should be at the heart level. ll�ֱ����Korotkoff��I���͵�V������ʧ����ȷ������ѹ������ѹ�� ll����ʱӦ������˫��Ѫѹ����Ϊ����Ѫ�ܲ����Ե�����������Ѫѹ�IJ�ͬ�������﷽������ʱӦ�Խϸ�һ��Ķ���Ϊ׼�� ll�����ˡ������˻������л�������λ�Ե�Ѫѹ�IJ��ˣ�Ӧ����ֱ��λ1���Ӻ�5���Ӻ��Ѫѹ�� ll�ڶ��β�����λѪѹʱ��Ӧ����������ʣ�30�룩�� Ҫ��5 Ѫѹ����llͨ��������Ѫѹ��Ϊ�ο�ll�������24Сʱ��̬Ѫѹ����и����ٴ���ֵ������Ѫѹ�����IJ��ˣ�ͬ�λ�ͬ�ξ���ʱ��������Ѫ��Σ�յͶ�����Ѫѹ�ߵIJ��ˡ�����Ѫѹ�ͼ�ͥ�Բ�Ѫѹ������ԵIJ��ˡ�����ҩ��������Ч�IJ��ˡ��о���ll������ü�ͥ�Բ�Ѫѹ��Ϊҽ������ƾ����ṩ������Ϣ����߲��˶����Ƶ�������ll����������˲��ü�ͥ�Բ�Ѫѹ�����²��˽��ǡ����²������иĶ����Ʒ���lr />l����Ѫѹ����̬Ѫѹ����ͥ�Բ�Ѫѹ����ֵ��ͬ�в����� Specific requirements are as follows: �� select the mercury sphygmomanometers meet measurement standards or international standards (BHS and AAMI) measure passed the inspection of electronic Sphygmomanometers. ��ʹ�ô�С���ʵ���������������Ӧ��80%�ϱۡ� Arm circumference of the majority 25-35cm, l 35cm, w 12-13cm balloon sleeve specifications; obesity or Bicep should use large size cuff; children using small cuffs. �DZ����������ٰ�����Ϣ5���ӣ��ڲ���ǰ30�����ڽ�ֹ���̻���ȣ��ſհ��ס� �ȱ�������ȡ��λ��������Σ���¶���ϱۣ��ϱ������ദ��ͬһˮƽ�� If you suspect that the peripheral vascular disease, doctor left, right upper arm blood pressure should be measured for the first time. Exceptional circumstances may be taken as a lying position or standing. Elderly, in patients with diabetes mellitus and orthostatic hypotension occurs, should be standing blood pressure measurement. Standing blood pressure in a lying position to 1 minute, and 5 minutes of standing time measurement. �� cuff closely tied to be measured in the upper arm, lower edge of the cuff should be 2.5cm on the bending of the elbow. Brachial artery beat places the stethoscope probes. �� measurements quickly inflated balloon rise 30mmHg following internal pressure is the radial artery pulsation disappear (4.0kPa), and then at a constant rate (2-6mmHg/sec) slow air release. Slow heart rate, and outgassing rate should be slower. After obtaining the diastolic blood pressure readings, quickly drop to zero. �� put gas in the process of listening carefully Korthof tone, observation of phase I of Caldwell's tone (the first tone) and phase v (disappearing tone) convex vertical mercury column heights. Systolic blood pressure readings taken phase I of Caldwell's tone, diastolic blood pressure readings taken Caldwell's phase v of the sound. ≪12 the age of children, pregnant women, severe anemia, hyperthyroidism, aortic regurgitation and Caldwell's music does not disappear, Korthof IV phase of the sound (tone) for diastolic blood pressure. �� unit mm Hg on clinical use of blood pressure (mmHg), China's official publications indicated in mm of mercury and kPa (kPa) conversion, lmmHg=0.133kPa. ��Ӧ���1-2�����ظ�������ȡ2�ζ����ƽ��ֵ��¼�� If the difference in systolic or diastolic blood pressure readings 2 times above 5mmHg, should be measured again, take 3 times average of the readings record. 3.4.2 self test blood pressure assessment of blood pressure and gravity, evaluation of antihypertensive effect, improved treatment compliance, enhance treatment for active participation, self test blood pressure with unique advantages. And without white coat effect, reproducibility is better. At present, the family self test evaluation of blood pressure and blood pressure in patients with guidance on antihypertensive therapy has become an important complement to the blood pressure clinics. However, the anxiety or frequently change treatments on their own patients according to blood pressure readings, self test blood pressure is not recommended. recommended in line with international standards (BHS and AAMI) of the upper arm, automatic or semiautomatic electron sphygmomanometer, normally the upper reference values: 135/85mmHg. Attention patients to the medical report may have a subjective self test blood pressure data select, reporting bias, consciously or unconsciously choose higher or lower in patients with blood pressure readings reported to the physician, affecting doctors judge the condition and modify the treatment. Memory storageAccording to the features electronic manometer can overcome deviations. Blood pressure readings reported either weekly or monthly averages. Family self test blood pressure lower than the blood pressure clinics, family self test blood pressure 140/90mmHg blood pressure 135/85mmHg equivalent to the clinic. people have suggested that the normal blood pressure measurement of blood pressure on a regular basis (20-29, once per two years, over 30 years old at least once a year). 3.4.3 dynamic ambulatory blood pressure measurement in compliance with international standards should be used (BHS and AAMI) monitor. Ambulatory blood pressure in normal domestic reference recommends the following criteria: 24 hours the average <130/80mmHg, <135/85mmHg the day average, average <125/75mmHg at night. Under normal conditions, nocturnal blood pressure values lower than the blood pressure values in daylight-10%. Ambulatory blood pressure monitoring can be used at the clinical diagnosis of white coat hypertension, masked hypertension, refractory hypertension, refractory seizures hypertension or hypotension, assessment of severity of hypertension, but the key is still used in clinical research, such as assessment of cardiovascular regulation mechanisms, prognosis, clinical assessment of new drugs or treatments, not a substitute for Clinic of blood pressure measurement. Ambulatory blood pressure measurements should be aware of the following issues: measuring time interval should be set to 30 minutes at a time. You can set the interval of time you want. ָ�������ճ������������˶��� When measuring blood pressure in patients with upper arm to keep stretch and rest. ���״μ������α���϶��ʹ����80%��Ԥ��ֵ��Ӧ�ٴβ����� 24-hour average blood pressure, blood pressure during the day or nocturnal blood pressure clinical decision making the reference, but tends to mean blood pressure 24 hours. 3.5 find target-organ damage and some clinical target organ damages judgment of total cardiovascular risk in patients with high blood pressure is very important and therefore should be carefully looking for evidence of target-organ damage. 3.5.1���ࣺ�ĵ�ͼ���ּ�ڷ����ļ�ȱѪ�����ഫ�����ͺ�����ʧ�������ҷʺ� Echocardiographic diagnosis of left ventricular hypertrophy and predict cardiovascular risk is undoubtedly superior to the ECG. Isotope imaging, magnetic resonance, cardiac exercise stress test, and when there is a special indication for coronary angiography (such as the diagnosis of coronary artery disease) can be applied. X-ray is also a useful diagnostic methods (understanding heart outlines, aortic or pulmonary circulation). 3.5.2 vessels: sonographic detection of carotid artery intima-media thickness (IMT) and plaques may predict stroke and myocardial infarction occurring value. Systolic blood pressure and pulse pressure as a predictor of cardiovascular events in the elderly is receiving increasing attention. Indices of pulse wave velocity measurement and enhancement of the measuring instrument is expected to develop into arterial compliance diagnostic tools. Endothelial cell dysfunction as an early marker of cardiovascular damage has also been widely concerned activity markers of endothelial cells (nitric oxide and its metabolites, et) to study possible provides an easy method for detection of endothelial function in the future. 3.5.3 kidney Hypertension diagnosis of renal impairment based mainly on increased serum creatinine, lowering the creatinine clearance rate and proteinuria (Microalbuminuria or large amounts of albumin in urine) excretion rate increases. High uric acid [>416mmol/L serum uric acid levels (7mg/DL)] is common in untreated patients with hypertension. Hyperuricemia associated with renal sclerosis. Elevated serum creatinine concentration tips reduced glomerular filtration rate, and albumin excretion increases tips glomerular filtration barrier dysfunction. Microalbuminuria strongly hint occurs in patients with type 1 and type 2 diabetes progression of diabetic nephropathy, proteinuria, renal lesion often prompted. Micro-albuminuria of non-diabetic patients with hypertension, cardiovascular events forecast values. Therefore, we recommend that all hypertension per capita for determination of serum creatinine and uric acid in serum and urine protein (cellulose paper check). 3.5.4�۵׾���飺��Wagener��Backer��Ѫѹ�۵׸ı��Ϊ�ļ��� Level 1 and level 2 78% in the prevalence of retinopathy in patients with hypertension, so the total cardiovascular risk stratification in evidence there as a target-organ damage in question. Level 3 and level 4 retinopathy is certainly serious complications of hypertension, fundus found bleeding, oozingAnd optic disc edema as coexistence of clinical situations. 3.5.5�ԣ�ͷ­CT��MRI�������������еı�׼������ MRI examination in patients with hypertension of nervous system anomalies is feasible. Cognitive impairment in the elderly, at least in part related to hypertension, hypertension can be used as cognitive assessment. 3.6 secondary screening for high blood pressure in hypertensive for adults about 5%~10% can find out the specific reasons for high blood pressure. Through clinical history, physical examination and routine laboratory screening for secondary hypertension can be simple. Following clue prompt with secondary hypertension may: �� severe or refractory hypertension; �� young onset; �� good sudden worsening of hypertension control; d sudden illness; �� with peripheral vascular disease and hypertension, to diagnosis procedures following such patients (see point 6). 3.6.1��ʵ���Ը�Ѫѹ��ʵ���Ը�Ѫѹ�����ļ̷��Ը�Ѫѹ�� (The most common type of chronic Glomerulonephritis, others include structural renal disease and obstructive nephropathy, and so on. ) All hypertension except for routine urine check when newly diagnosed by screening renal hypertension. Physical examination of bilateral touches upper abdominal mass, suspected polycystic kidney disease, and abdominal ultrasound, helps clear diagnosis. Measuring urine protein, such as red blood cells and white blood cells and serum creatinine concentration, Glomerular and renal tubular function can help you understand. Ҫ��6�̷��Ը�Ѫѹ�������𺦵��������ʾ�̷��Ը�Ѫѹ�������𺦵�����ll���ϣ�Cushing���ۺ�������ll����ά����Ƥ���ߣ��ȸ�ϸ����ll�������������󣨶�����ll�����и�����������Ѫ���Ը�Ѫѹ��ll��������ǰ����ز���������������խ������������ll>�ɶ���������ʧ���ز���������������խ������������ll�ɶ���������ʧ���ӳ١��ɶ���ѹ���ͣ���������խ�����������������𺦵�����ll�ԣ��������������˶���о�ȱʧll�۵ף��۵׾�����쳣ll���ࣺ�ļⲫ����λ�ü����ʣ�����ʧ�������Ա����ɣ��β�������������ˮ��ll����Ѫ�ܣ�������ʧ�������򲻶Գƣ�֫�˷��䣻Ƥ��ȱѪ�Ըı�wbr>3.6.2��Ѫ���Ը�Ѫѹ��Ѫ���Ը�Ѫѹ�Ǽ̷��Ը�Ѫѹ�ĵڶ�λԭ�� Foreign 75% in patients with renal artery stenosis is caused by atherosclerosis (especially in the elderly). In China, Arteritis was one of the important causes of renal artery stenosis in young people. Fibers of muscle hypoplasia in the less common in China. On signs of renal artery stenosis is the umbilical cord to the unilateral conductive hearing and vascular murmur, but is not common. Laboratory tests make it possible to discover high plasma Renin, hypokalemia. Decrease in renal function and renal patients with loss of volume is late manifestation. Ultrasound check of renal artery, enhanced spiral CT, magnetic resonance angiography, digital subtraction angiography, useful for diagnosing. Renal artery by color Doppler ultrasound examination, is the high sensitivity and specificity of non-invasive screening tool. Renal Arteriography can be confirmed. 3.6.3 pheochromocytoma pheochromocytoma is a rare form of secondary hypertension, detection of Catecholamines in urine and blood catecholamine hypersecretion clearly exists. Ultrasound or CT checked may make a diagnosis. 3.6.4 primary aldosteronism as a screening method for detection of serum potassium level. Deactivate Renin drug effects (such as the b-blockers, ACEI), plasma Renin activity in significantly lower (<1NG/ml/h), and significantly increases plasma aldosterone levels indicates that the disease. Plasma aldosterone (NG/DL) and plasma Renin activity (ng/ml/h) ratio is greater than 50, height hint of primary aldosteronism. CT/MRI checks help to determine whether the adenoma or hyperplasia. 3.7.5�����ۺ���(Cushing��s syndrome)�����ۺ����е�80%���Ѫѹ�� Typical body size in patients with this syndrome often prompted. Reliable measurement indicators are 24-hour urine hydrocortisone pine level, >110nmol/L (40ng) height hints of this disease. 3.6.6Drug-induced hypertension drug for hypertension: licorice, oral contraceptives, steroids, non-steroidal anti-inflammatory drugs, cocaine, amphetamines, erythropoietin and the effects of cyclosporin a and so on. 3.7�Ŵ�ѧ����wbr>�Ŵ�ѧ�����ڸ�Ѫѹ���˵ij������������������в���ȷ�� Family history of hypertension patients often prompts role on the pathogenesis of essential hypertension has some genetic factors. Causes of high blood pressure is a Polygenic diseases. Genetic analysis to confirm or rule out rare monogenic inherited hypertension has a certain value (Liddle's syndrome, etc). 4. the definition and classification of blood pressure 4.1 systolic pressure, diastolic blood pressure and pulse pressure, diastolic pressure as predictors of cardiovascular disease has been considered more important than systolic blood pressure of predictors of coronary heart disease and cerebrovascular disease. After the 90 's, many observational studies confirmed both systolic and diastolic blood pressure associated with stroke and coronary heart disease risk independently, and this relationship is continuous incremental. Systolic blood pressure is also an important predictor of cerebrovascular disease and coronary heart disease risk, study suggests older SPE more great harm. The elderly increased systolic blood pressure increases with age, while diastolic blood pressure decline slowly after the age of 60. Study suggests systolic blood pressure and coronary heart disease and stroke are relevant. Some information is also displayed pulse pressure increase in the elderly than systolic pressure and diastolic blood pressure is more important predictor of cardiovascular events, total baseline pulse pressure and death in the elderly, and cardiovascular death, stroke and coronary heart disease is a significant positive correlation. Relevant randomised trials or proof of antihypertensive treatment in patients with isolated systolic hypertension is useful. In view of already existing is supported by a series of large randomized controlled trial on isolated systolic hypertension and diastolic hypertension be treated and, therefore, we remain focused on clinical practice using systolic and diastolic blood pressure levels to guide treatment. Noticed on blood pressure assessed in systolic and diastolic blood pressure effect of an overall assessment. Classification and risk assessment of hypertension (see table 3, table 5) aimed at use of systolic and diastolic blood pressure on blood pressure and total risk stratification. Ratings and risk stratification of high blood pressure now continues to be a simple and practical way. 4.2 classified according to blood pressure relationships between blood pressure and cardiovascular risk is continuous and, therefore, on any number of definitions and classifications are hypertension was arbitrary. High blood pressure must be flexible for any number of definitions, should be based on the treatment of drug efficacy and tolerability and vary depending on the level of risk. Blood pressure is normal, normal, high value and high blood pressure. JNC-7 blood pressure 120-139/80-89mmHg as Prehypertension, has the potential to cause alarm to the spirit of this part of the population, and the lack of evidence. 120-139/80-89mmHg as a normal value, is because of our epidemiological studies have shown that this crowd in 10 years cardiovascular risk compared with <110/75mmHg in subjects increased more than 1 time. Blood pressure 120-129/80-84mmHg and 130-139/85-89mmHg middle-aged 10 per cent of patients with hypertension and 45%. High normal blood pressure values the crowd should be promoted to improve lifestyle, to prevent the occurrence of hypertension and cardiovascular disease. This guide basically retained in 1999 Chinese hypertensive blood pressure classification Guide. Remove "critical" subgroup of high blood pressure (see table 3). High blood pressure is defined as: unused antihypertensive drug cases, systolic blood pressure �� 140mmHg and/or diastolic blood pressure �� 90mmHg, hypertensive blood pressure levels are divided into level 1,2,3. Systolic and diastolic blood pressure �� 140mmHg <90mmHg as isolated systolic hypertension. In patients with previous history of high blood pressure, is currently with antihypertensive drugs, blood pressure less than 140/90mmHg, we should also diagnosed with high blood pressure. 4.3 risk stratification of hypertension: hypertension patient care decisions are not only based on blood pressure levels, also based on the following aspects: �� other risk factors; �� target-organ damage; �� coexisting medical situation ruxin, cerebrovascular disease, kidney disease and diabetes mellitus; �� patients ' individual circumstances and economic conditions, and so on. For the purposes of risk stratification, WHO/ISH Guide under "Framingham Heart study" the observation object 10 cardiovascular death, non-lethal and non-fatal myocardial infarction, stroke, information, calculate the merging of several risk factors present effect on the absolute risk of cardiovascular events in the future (see table 4 and table 5). table 3 blood pressure level of defines and classification category shrink pressure (mmHg) diastolic pressure (mmHg) normal blood pressure <120<80 normal high value 120~13980~89 hypertension: �� 140 �� 90 1 level hypertension (mild) 140~15990~99 2 level hypertension (in the degrees) 160~179100~109 3 level hypertension (heavy degrees) �� 180 �� 110 simple shrink period hypertension �� 140<90 if patients of shrink pressure and diastolic pressure min is different of level Shi, is to high of ratings for quasi. Isolated systolic hypertension can also be in accordance with the level of systolic blood pressure is at level 1, 2, 3. Table 4>Ӱ��Ԥ���������Ѫ�ܲ���Σ�����ذ����ٵ��𺦣�TOD�����򲡲�����ٴ����ACC��������ѹ������ѹˮƽ��1~3�����������ҷʺ�ո�Ѫ�ǡ�7.0mmol/L����Ѫ�ܲ�������>55���ĵ�ͼ( 126mg/dL�� ȱѪ�����С�Ů��>65�곬���Ķ�ͼ��LVMI�ͺ�Ѫ�ǡ�11.1mmol/L�Գ�Ѫ����X��( 200mg/dL�� ��������ȱѪ������Ѫ֬�쳣������������wbr>�����༲��TC��5.7mmol/L����������IMT��0.9mm �ļ�����ʷ��220mg/dL����������Ӳ���԰߿�wbr> �Ľ�ʹ��LDL-C>3.6mmol/L�ij������ ��״����Ѫ���ؽ���140mg/dL����Ѫ�弡�������wbr> ��Ѫ������˥�� ��HDL-C<1.0mmol/L����115~133mmol/L�����༲����40mg/dL����1.3~1.5md/dL�������������緢��Ѫ�ܲ�����ʷŮ��107~124mmol/L����������Ѫ�弡��һ����������������lt;50�꣨1.2~1.4mg/dL������>133mmol/L�����ͷ��ֻ���֡�΢���׵�����wbr>(1.5mg/dL)���ͷ��� *WC���ԡ�85cm��׵���30~300mg/24hŮ��>124mmol/LŮ�ԡ�80cm�׵���/����ȣ�(1.4md/dL)����BMI��28kg/m2���ԡ�22mg/g������>300mg/24h����ȱ���������2.5mg/mmol��������Ѫ�ܼ���Ů�ԡ�31mg/g������C��Ӧ���ס�3mg/L ��C��Ӧ���ס�10mg/L��3.5mg/mmol��������Ĥ���䣺��Ѫ�����������ͷˮ��TC���ܵ��̴���LDC-C�����ܶ�֬���׵��̴���HDL-C�����ܶ�֬���׵��̴���LVMI����������ָ��IMT����������Ĥ�в��ȣ�BMI������ָ��WC���� * Obesity working group on standards in China