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1、改善血压控制的质量和内涵,降低和控制清晨高血压张维忠,以长期高质量血压控制和预防或逆转靶器官损害为目标的优化治疗，更有利于指导降压治疗，并获得更大程度的益处。优化治疗策略需要优选降压治疗的基本元素、剂量以及联合治疗方案与路径，2009年ESH治疗指南再评价提出 Preferred drugs，Preferred combinations。,降压治疗策略的新理念,Clinic BP can represent the whole blood pressure status?,-20,-15,-10,-5,0,Drug A（highT/P ratio）,Drug B（low T/P ratio）,
2、Clinic BP Routine time of measurement,ABPM,Drug delivery,Neutel JM,Blood Pressure Monitoring 2001,6:9-16,Average BP change(mmHg),Dolan,E.et al.Hypertension 2005;46:15661,Superior predictive value of ABP on CV mortality,The Finn-Home Study,The Finn-Home Study.Hypertension 2012,59:212-218,Prognostic V
3、alue of the Variability in Home-Measured Blood Pressure and Heart Rate,24-h Blood Pressure Profile,Time of day,Blood pressure(mm Hg),18:00 22:00 02:00 06:00 10:00 14:00 18:00,Time of awakening,Sleep,180,160,140,120,100,80,Millar-Craig et al,1978;Mancia et al,1983,清晨高血压Morning Hypertension,清晨高血压:清晨时段
4、血压升高(135/85 mmHg)清晨高血压是隐蔽性高血压(Masked Hypertension)的一种主要表现 清晨高血压与血压晨峰或血压昼夜节律异常 有密切关系,Cohen,MC,et al.Am J Cardiol 1997;79:1512-1516Elliolt WJ Stroke 1998;29:992-996,CV Event is Highest In the Morning,*Relative risk(95%Cl)based on proportion of actual number of incidence versus expectednumber of incide
5、nce(if no circadian variations existed),50,40,30,20,10,0,Acute Ml,Stroke,Increase in relative risk(%)*,38%,49%,Br J Cardiol 2008;15:31-34,High incident of Stroke&MI,清晨血压与心血管风险密切相关,Kario K,et al.Diabetes Care 2002;25:2218-2223.,Morning hypertension and complications in Patients with type 2 diabetes,7
6、0,60,50,40,30,20,10,0,Morning normotensives(n=73)Morning hypertensives(n=97),p0.01,Prevalenceofcomplications(%),Neuropathy,Retinopathy,CoronaryArtery disease,Cerebrovasculardisease,Hypertension status and diabetes on silent cerebral infarct,Eguchi K,et al.Stroke 2003;34:2471-2474.,Morning hypertensi
7、on and left ventricular hypertrophyIn medicated patients with hypertensive,Data presented at the 2003 Annual Scientific Meeting of Japanese Society of Hypertension,Miyazaki,Japan.,White-coathypertension(n=59),White-coathypertension(morning surge),Sustainedhypertension(n=44),Morninghypertension(n=27)
8、,P=0.001,P=0.01,P=0.01,200,100,0,Left ventricularMass index(g/m2),ME average(mmHg)127.3127.1142.4143.5 ME surge(mmHg)8.4247.325,Caramori ML,et al.N Engl J Med 2003;348:260-264,160,140,120,100,80,40,60,80,100,120,DiastolicPressure(mmHg),SystolicPressure(mmHg),P=0.005,P=0.003,Morning,Daytime,Night-tim
9、e,Morning,Daytime,Night-time,Microalbuminuria(n=14)Nonmoaibuminuria(n=17),NS,NS,NS,NS,Morning blood pressure and microalbuminuriaIn newly diagnosed diabetic patients,改善血压控制的质量和内涵,有效控制24小时血压水平控制夜间高血压控制清晨高血压减轻长时血压变异,Blood pressure control in the risky early-morning hours,Redon J et al.Blood Press Moni
10、t 2002;7:111-118Kario K et al.Circulation 2003;108:72e-73e,70,60,50,40,30,20,10,0,Controlled(morning SBP/DBP 135/85 mmHg),Not controlled,Patients(%),ACAMPA(ABPM),J-MORE(HBPM),Two studies in patients with controlled office BP have shown poor control of mean morning BP,控制清晨高血压的治疗方法,使用超长效降压药物将给药时间改为临睡前
11、使用长效1阻滞剂多沙唑嗪控释片,苯磺酸氨氯地平长效的药理学机制,氨氯地平的血浆半衰期长达35-50小时。氨氯地平的分子侧链带正电荷，与带负 电荷的细胞膜结合，能持久地发挥阻滞 血管平滑肌细胞L型钙通道作用。,苯磺酸氨氯地平的化学结构和作用机制,苯磺酸氨氯地平的化学结构,氨氯地平与细胞膜的作用受电荷平衡影响,Morning dosing of amlodipineon morning BP in hypertensive patients,40,20,0,-20,-40,-60,-80,120,140,160,180,200,220,Baseline morning systolic BP(mm
12、Hg),4/35=11%,AmlodipinegroupReductionof morningsystolicBP(mmHg),r=-0.73P0.001n=38,Nonresponders,Eguchi K,et al.Am J Hypertens 2004;17:112-117,Morning dosing of valsartanon morning BP in hypertensive patients,40,20,0,-20,-40,-60,-80,120,140,160,180,200,220,Baseline morning systolic BP(mmHg),15/33=45%
13、,ValsartangroupReductionof morningsystolicBP(mmHg),r=-0.53p=0.001n=38,Eguchi K,et al.Am J Hypertens 2004;17:112-117,Nonresponders,络活喜有效控制24h和清晨血压,Clin.Drug Invest.1997;13(Suppl 1):67-72AJH 1998;11:690696,苯磺酸氨氯地平能长期有效平稳地控制外周和中心动脉的血压水平，阻止或减轻心、血管病变进展；降低短时和长时血压变异，控制清晨高血压，恢复血压正常昼夜节律,有助于减少触发心、脑血管病发生的机率。因此，苯磺酸氨氯地平是当代降压治疗优选的基本元素。,苯磺酸氨氯地平降压治疗优点,
