高血壓聯盟與轉化醫學

劉力生PurposeofWHLTodeveloporpromotehealthbyeducatingandinstructinghealthcareprofessionalsandthepubliconpreventativeandcurativemeasuresforhypertension.對專業人員和群眾進行

健康促進教育Topromoteandconductresearchrelatedtothepreventionandtreatmentofhypertension促進和組織防治高血壓的研究項目

Topromotethedetection,controlandpreventionofhypertensioninthepopulationthroughjointeffortsofallnationalleaguesandsocieties.

聯合各國的聯盟與學會促進高血壓防控工作Toliaisewiththenationalbodies,promotingtheexchangeofinformationamongthem,andofferinginternationallyapplicablemethodsandprogramsforhypertensioncontrol.與各國家團體聯系,交流提供有關控制高血壓的國際可行的方法與計劃.轉化醫學與中國高血壓聯盟轉化醫學是本世紀從循證醫學發展而形成的一個醫學實踐和干預性流行病學的理念，它融匯基礎科學、社會科學、政治科學于一體，兼顧治病和預防，其涵蓋的領域已超出現行醫療保健服務的范疇。Frombenchtobedsidetopopulation(實驗室—臨床—社區）

轉化醫學研究可分為： 1期：基礎實驗研究 2期：基礎研究應用于臨床:臨床試驗,中國高血壓指南 3期：改變環境與政策層面的因素才能做到臨床公共衛生和預防措施的可持續發展。健康促進與社區防治

HypertensionClinicalTrials

中國臨床試驗的經驗

LiuLishengChronicDiseaseinChina

-2007CVDReportofChina

中國慢病現狀Newonsetstroke:2million/yr，Survivedstroke:13millionCVDpatients:230millionNewonsetMI:

0.5million，survivedMI:3million；CHD:8milllionPatientswithchronicdiseasesin2003:574million：DM: 33million--Cancer: 46millionCerebrovasculardiseases: 93millionCardiacdisease:

165millionHypertension: 237millionTrialsYearContributionsSyst.-ChinaChineseSystolicHT

intheElderlyTrial1998Totalmortality,CVDmortality&StrokemortalityreducedbyCCBbasedtreatmentinisolatedsystolicHTptsPATsPostStrokeAntiHTTreatmentStudy1996BPreductioninpoststrokepts.Reducedstrokerecurrence,eveninnormotensiveSTONEAntihypertensive

tr.in

elderlyCCBeffectiveinstrokereductioninelderhypertensivesFEVERChineseFelodipineEventReductionTrial2004MoreorlessantihypertensivetreatmentonstrokeHypertensionClinicalTrialsinChinaTrialsYearContributionsPROGRESSThePerindoprilProtectionAgainstRecurrentStrokeStudy

2001PoststrokeantihypertensivetreatmenteffectivelyreducedtherecurrenceofstrokeinpatientssufferedfromstrokeCREATEClinicalTrialofReviparinandMetabolicModulationinAcuteMyocardialInfarctionTreatmentEvaluation2005PostMI:useofreviparinisbeneficialADVANCEActionindiabetes&VascularDisease:PreteraxandDiamicaronMrControlledEvaluaton2006Antihypertensivetr.reducetheeventsofmacro-andmicro-vasculareventsinpatientswithDM(bloodpressurearm)InternationalTrialsTrialsYearContributions&problemsWAVETheWarfarinAntiplateletVascularEvaluationStudymorehemorragicsideeffectsinChineseOASIS-6OrganizationfortheAssessmentofStrategiesforIschemicSyndromes-62006POISEEffectsofextended-releasemetoprololsuccinateinpatientsundergoingnon-cardiacsurgery2008InternationalTrialsTrialsYearContributionsONTARGET/TRANSENDOngoingTelmisartanAloneandinCombinationwithRamiprilGlobalEndpointtrial/TelmisartanRandomizedAssessmentStudyinACEIntolerantSubjectswithCVD2008RASblocadetreatmenteffectivelyreduceCVDeventswitheitherACEIorARBratherthanbothHYVETTheHypertensionintheVeryElderlyTri2008AntihypertensivetreatmentreducedmajorCVDeventsandmortalityinveryelderly(>=80yrs)hypertensivepatientsInternationalTrialsExperience(1/2)Easiertorecruitparticipantsfromclinicsor

communities.

Concommitantdrugtreatmentareless.

largesimpletrialsarefeasible

inChina.Example:Chinesesubjects

inHYVET

(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-way

streetDrivetocureshouldbecomplementedbygoingbackfrombedsidetolaboratorywith

observationsmadeinhumanstudiesPharmacogenetics

&individualized

medicineWarfarin

dosage

inAsianpeopleCanfolicacidpreventstroke?ChinaStrokePrimaryPreventionTrial

Warfarinmaintenancedosesvaryamongdifferentpopulations:Asiansrequirelowerdoses

EthnicityWarfarindoseReferencesAsianChinese3.3(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.“CertainsinglenucleotidepolymorphismsintheVKORC1gene(especiallythe-1639G>Aallele)havebeenassociatedwithlowerdoserequirementsforwarfarin”.DescriptionofcurrentchangestotheCrestorlabelInapharmacokineticstudyinvolvingadiversepopulationof

AsiansresidingintheUnitedStates,rosuvastatindruglevels

werefoundtobe

elevatedapproximately2-fold

comparedwithaCaucasiancontrolgroup.Asaresultofthesefindings,the“DosageandAdministration”sectionofthelabelnowstatesthatthe

5mgdoseofCrestorshouldbeconsideredasthestartdoseforAsianpatients

andanyincreaseindoseshouldtakeintoconsiderationtheincreaseddrugexposureinthispatientpopulation.Resultsofthispharmacokineticstudyarefurtherdiscussedunderthe“ClinicalPharmacology”and“Precautions”sectionoflabeling.EthnicallyDifferentDoseRecommendationPharmacogenetics

&individualized

medicineWarfarin

dosageinRCT(wavestudy)Canfolicacidprevent

stroke?

ChinaStrokePrimary

PreventionTrial中國高血壓指南項目設計開放性、多中心的橫斷面觀察性登記研究，入組已接受降壓藥物治療的門診高血壓患者全國22個城市，100家三甲醫院涉及心血管科、腎內科、內分泌科納入5000例高血壓患者以下問題為本研究關注重點：-患者的人口學特征-患者的血壓控制情況-患者的心血管危險因素及相關實驗室檢查結果-患者的降壓藥物應用情況-患者的關于高血壓治療的認知狀況的調查Surveyof

hyperTensive

pAtienTs

blood

pressUre

controlrateinclinic

Service兩大權威機構聯合發起并主辦總結三甲醫院心血管科、腎內科、內分泌科門診高血壓患者血壓<140/90mmHg達標率為45.1%糖尿病或腎病患者血壓(<130/80mmHg)和其他患者（<140/90mmHg）血壓達標率為31.1%最常見的合并疾病依次為血脂異常(43.2%)、糖尿病(37.1%)、冠心病(22.6%)及腎功能不全(18.3%)68.9%1992--1994199820022009BP未達標BP達標已接受治療的高血壓患者中血壓<140/90mmHg不斷提高！2006年中國心血管病報告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%CHINASTATUS數據引發的思考但我們仍然面臨挑戰31.1%的達標率對我們是否已經足夠好?多數高血壓患者合并其他疾病，降壓需要更關注器官的保護60%的患者從不漏服降壓藥物，而總體達標率31.1%，(<140/90mmHg為45.1%)提示我們是否應該選擇更強更有效的治療方案，以使血壓盡早達標。

我們仍要為提高我國高血壓患者的知曉率，治療率和達標率、繼續努力！繼續教育與宣傳群眾可持續發展的社區防治EpidemiologicalreportfromChinaDATAFROM5-AND10–YEARFOLLOW-UPSURVEYSOF10,450WORKERS