《循证医学与心衰治疗.ppt

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2016-12-29 发布于四川
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《循证医学与心衰治疗.ppt

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Captopril 0 0.1 0.2 0.3 0.4 0 6 12 18 24 30 36 Months Probability of Event Study DrugDiscontinuation Overall Due to Adverse Events *P 0.05 vs Captopril Valsartan + Captopril * * Valsartan * Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. * * * * Valsartan ? ? Valsartan + Captopril Captopril Hypo- Renal Hyper- Cough Skin Taste Angio- tension Causes kalemia Rash Disturbance edema Adverse Experience Leading to Study Drug Discontinuation * P 0.05 Valsartan vs. Captopril ?P 0.05 Valsartan + Captopril vs. Captopril 0 0.5 1 1.5 2 2.5 3 3.5 % of Patients n = 201 154 23 253 90 46 34 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. VALIANT研究的意义第一次证实ARB改善急性心梗患者生存率作用与已证实剂量ACEI相当缬沙坦与证实剂量的卡托普利联合使用未能进一步降低死亡率缬沙坦可代替ACEI用于急性心梗患者 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. CHARM Added CHARMPreserved CHARM研究 3 component trials comparing candesartan to placebo in patients with symptomatic heart failure CHARMAlternative n=2028 LVEF ￡40%ACE inhibitor intolerant n=2548 LVEF ￡40%ACE inhibitor treated n=3025 LVEF 40%ACE inhibitor treated/not treated Primary outcome for Overall Programme: All-cause death Primary outcome for each trial: CV death or CHF hospitalisation Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. CHARM-Alternative: Primary outcome CV death or CHF hospitalisation 0 1 2 3 years 0 10 20 30 40 50 Placebo Candesartan % HR 0.77 (95% CI 0.67-0.89), p=0.0004Adjusted HR 0.70, p0.0001 Number at risk Candesartan 1013 929 831 434 122 Placebo 1015 887 798 427 126 3.5 406 (40.0%) 334 (33.0%) Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. CHARM-Added: Primary outcomeCV death or CHF hospitalisation 0 1 2 3 years 0 10 20 30