高血压联盟与转化医学.pptx

高血压联盟高血压联盟与与转化医学转化医学 刘力生刘力生 PurposeofWHLTodeveloporpromotehealthbyeducatingandinstructinghealthcareprofessionalsandthepubliconpreventativeandcurativemeasuresforhypertension.对专业人员和群众进行对专业人员和群众进行健康促进教育健康促进教育Topromoteandconductresearchrelatedtothepreventionandtreatmentofhypertension促进和组织防治高血压的研究项目促进和组织防治高血压的研究项目Topromotethedetection,controlandpreventionofhypertensioninthepopulationthroughjointeffortsofallnationalleaguesandsocieties.联合各国的联盟与学会促进高血压防控工作联合各国的联盟与学会促进高血压防控工作Toliaisewiththenationalbodies,promotingtheexchangeofinformationamongthem,andofferinginternationallyapplicablemethodsandprogramsforhypertensioncontrol.与各国家团体联系,交流提供有关控制高血压的国际可行的方法与计划.转化医学与中国高血压联盟转化医学与中国高血压联盟转化医学是本世纪从循证医学发展而形成的一个医学实践转化医学是本世纪从循证医学发展而形成的一个医学实践和干预性流行病学的理念，它融汇基础科学、社会科学、和干预性流行病学的理念，它融汇基础科学、社会科学、政治科学于一体，兼顾治病和预防，其涵盖的领域已超出政治科学于一体，兼顾治病和预防，其涵盖的领域已超出现行医疗保健服务的范畴。现行医疗保健服务的范畴。Frombenchtobedsidetopopulation(实验室实验室临床临床社区）社区）转化医学研究可分为：转化医学研究可分为：1期：基础实验研究期：基础实验研究2期：基础研究应用于临床期：基础研究应用于临床:临床试验临床试验,中国高血压指南中国高血压指南3期：改变环境与政策层面的因素才能做到临床公共卫期：改变环境与政策层面的因素才能做到临床公共卫生和预防措施的可持续发展。生和预防措施的可持续发展。健康促进与社区防治健康促进与社区防治HypertensionClinicalTrials中国临床试验的经验 LiuLishengChronicDiseaseinChina-2007CVDReportofChina中国慢病现状中国慢病现状1.Newonsetstroke:2million/yr，Survivedstroke:13million2.CVDpatients:230million3.NewonsetMI:0.5million，survivedMI:3million；CHD:8milllion4.Patientswithchronicdiseasesin2003:574million：DM:33million-Cancer:46millionCerebrovasculardiseases:93millionCardiacdisease:165millionHypertension:237millionTrialsYear ContributionsSyst.-ChinaChinese Systolic HT in the Elderly Trial 1998Total mortality,CVD mortality&Stroke mortality reduced by CCB based treatment in isolated systolic HT ptsPATs Post Stroke Anti HT Treatment Study 1996 BP reduction in post stroke pts.Reduced stroke recurrence,even in normotensive STONE Antihypertensive tr.in elderlyCCB effective in stroke reduction in elder hypertensivesFEVERChinese Felodipine Event Reduction Trial2004 More or less antihypertensive treatment on stroke HypertensionClinicalTrialsinChinaTrialsYear ContributionsPROGRESSThe Perindopril Protection Against Recurrent Stroke Study 2001Post stroke antihypertensive treatment effectively reduced the recurrence of stroke in patients suffered from strokeCREATEClinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation2005Post MI:use of reviparin is beneficialADVANCEAction in diabetes&Vascular Disease:Preterax and Diamicaron Mr Controlled Evaluaton2006Antihypertensive tr.reduce the events of macro-and micro-vascular events in patients with DM(blood pressure arm)InternationalTrialsTrialsYear Contributions&problemsWAVE The Warfarin Antiplatelet Vascular Evaluation Study more hemorragic side effects in ChineseOASIS-6Organization for the Assessment of Strategies for Ischemic Syndromes-62006POISEEffects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery2008InternationalTrialsTrialsYear ContributionsONTARGET/TRANSEND Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint trial/Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with CVD2008RAS blocade treatment effectively reduce CVD events with either ACEI or ARB rather than bothHYVETThe Hypertension in the Very Elderly Tri 2008Antihypertensive treatment reduced major CVD events and mortality in very elderly(=80 yrs)hypertensive patientsInternationalTrialsExperience(1/2)Easiertorecruitparticipantsfromclinicsorcommunities.Concommitantdrugtreatmentareless.largesimpletrialsarefeasibleinChina.Example:ChinesesubjectsinHYVET(40%oftotalsample)Slightlyyounger,lighter&shorter.Smokedmorebutdranklessalcohol.LesspreviousepisodesofMI,morepreviousstrokeHadlowerbloodurea,uricacidandCr,higherHDLC.Bloodglucose&TC,Na&K,bloodhaematocrit&Hbwerealllower.Mucheasiertorecruit,lessconcomitanttr.Morecomplianttotr.EasiertoFU.Experience(2/2)CHLwasestablishedontopofSyst.-China&PATsCollaborativegroup(31medicaluniversities)in1989&continuingonorganizingRCTsbothnationally&internationalyEstablishedgoodrelationshipwithworldwellknownRCTCenters,implicatingRCTresultsinChinesepopulationsuccessfully.Forex.CCBbasedtr.usedwidelyinISH,captoprilinpostMIafterSyst-ChinaandCCS1trials.Translationalmedicineisatwo-waystreetDrivetocureshouldbecomplementedbygoingbackfrombedsidetolaboratorywithobservationsmadeinhumanstudiesPharmacogenetics&individualizedmedicineWarfarindosageinAsianpeopleCanfolicacidpreventstroke?ChinaStrokePrimaryPreventionTrial Warfarinmaintenancedosesvaryamongdifferentpopulations:Asiansrequirelowerdoses EthnicityWarfarin doseReferencesAsianChinese3.3(mg/day)Q.J.Med.89,127-135Japanese3.3(mg/day)Clin.Pharmacol.Ther.63,519-528CaucasianAmerican5.1(mg/day)JAMA,287,1690-1698.Italian5.5(mg/day)Blood,105,645-649.“Certain single nucleotide polymorphisms in the VKORC1 gene(especially the-1639GA allele)have been associated with lower dose requirements for warfarin”.Description of current changes to the Crestor labelIn a pharmacokinetic study involving a diverse population of Asians residing in the United States,rosuvastatin drug levels were found to be elevated approximately 2-fold compared with a Caucasian control group.As a result of these findings,the“Dosage and Administration”section of the label now states that the 5 mg dose of Crestor should be considered as the start dose for Asian patients and any increase in dose should take into consideration the increased drug exposure in this patient population.Results of this pharmacokinetic study are further discussed under the“Clinical Pharmacology”and“Precautions”section of labeling.Ethnically Different Dose RecommendationPharmacogenetics&individualizedmedicineWarfarindosageinRCT(wavestudy)Canfolicacidpreventstroke?ChinaStrokePrimaryPreventionTrial中国高血压指南中国高血压指南项目设计项目设计开放性、多中心的横断面观察性登记研究横断面观察性登记研究，入组已接受降压药物治疗的门诊高血压患者全国2222个个个个城市，100100家家家家三甲医院涉及心血管科、肾内科、心血管科、肾内科、心血管科、肾内科、心血管科、肾内科、内分泌科内分泌科内分泌科内分泌科纳入50005000例例例例高血压患者以下问题为本研究关注重点：-患者的人口学特征-患者的血压控制情况-患者的心血管危险因素及相关实验室检查结果-患者的降压药物应用情况-患者的关于高血压治疗的认知状况的调查Survey of hyperTensive pAtienTs blood pressUre control rate in clinic Service两大权威机构两大权威机构联合发起并主办总结总结三甲医院三甲医院心血管科、肾内科、内分泌科心血管科、肾内科、内分泌科门诊高血压患者门诊高血压患者血压140/90mmHg达标率为45.1%糖尿病或肾病患者血压(130/80mmHg)和其他患者（140/90mmHg）血压达标率为31.1%最常见的合并疾病依次为血脂异常(43.2%)、糖尿病(37.1%)、冠心病(22.6%)及肾功能不全(18.3%)68.9%1992-1994199820022009BP未达标未达标BP达标达标已接受治疗的高血压患者中血压已接受治疗的高血压患者中血压140/90mmHg不断提高！不断提高！2006年中国心血管病报告0%20%40%60%80%100%87.3%80.1%75%54.9%12.7%19.9%25.0%87.3%80.1%75%54.9%12.7%19.9%25.0%45.1%68.9%31.1%31.1%45.1%CHINA STATUS数据引发的思考引发的思考 但我们仍然面临挑战31.1%的达标率对我们是否已经足够好?多数高血压患者合并其他疾病，降压需要更关注器官的保护60%的患者从不漏服降压药物，而总体达标率31.1%，(140/90mmHg为45.1%)提示我们是否应该选择更强更有效的治疗方案，以使血压尽早达标。我们仍要为提高我国高血压患者的知晓率，治疗率和达标率、继续努力！继续教育与宣传群众继续教育与宣传群众可持续发展的社区防治可持续发展的社区防治EpidemiologicalreportfromChinaDATAFROM5-AND10YEARFOLLOW-UPSURVEYSOF10,450WORKERS本文刊登于MildHypertensionRecentAdvances1983年Pilot Trial ExperienceOrganization is guarantee -Arrange at every levelZhejiang provinceStressed on Propaganda Pilot Trial ExperienceHenanQinghaiYunnanShandongAnhuiHunanSichuanGuizhouGansuHainanTianjinHeilongjiang BeijingShanghaiHebeiXizangJilinNeimengguLiaoningHubeiJiangsuXinjiangShaanxiShanxiGuangdongNingxiaGuangxiZhejiangJiangxiFujianTaiwanNext 结语努力实践转化医学，做好联盟工作上医治未病实现健康中国2020谢谢！