老年高血压治疗教材分析.ppt

* * 从 随机入组前一个月开始，给所有登记患者服用雅施达4mg/天，共2周，然后将剂量加至8mg/天，服用2周，能耐受的患者将被随机到试验药物组或安慰剂组。 EUROPA试验????这项对12218例无心力衰竭的稳定性冠心病患者平均随访4.2年的研究显示,培哚普利使主要终点事件——心血管死亡、心肌梗死和复苏的心脏骤停风险降低20%(P=0.0003)。EUROPA亚研究PERTINENT揭示了培哚普利可改善内皮细胞功能并减少其凋亡的作用。对PROGRESS和EUROPA研究进一步分析还显示,培哚普利可显著改善合并糖尿病的心脑血管病患者的预后。 10/24/97 1 J:\artem\F151097\Europa PREAMI involved 1252 MI patients aged 65 or over (average age 73) with preserved left ventricular function. Patients were involved in the trial 11+/4 days after Acute Myocardial Infarction Patients received evidence-based therapy after acute MI, including ACE Inhibitor. They were included (received the treatment) within 20 days from MI and after at least 24 h ACE-I wash-out. The patients kept all the other concomitant medication. They were randomly allocated either Coversyl or placebo. Those who were allocated Coversyl started with 4 mg for a months and increased the dosage to 8 mg. * 涉及1252例患者的PREAMI研究证实，雅施达?治疗一年，可逆转急性心肌梗死后患者左室重构发生率达46％。 * EUROPA研究、PREAMI研究和ASCOT研究均证实，培哚普利8mg是心血管保护作用的循证剂量 * * 开放性多中心研究，对109例稳定性冠心病患者，基线血压136.5±15.3/80.3±10.6mmHg。入组已服用培哚普利4mg/d至少4周后调整剂量至8mg/d治疗2个月，观察增量后 的安全性与耐受性 * 氨氯地平 ± 培哚普利(4-8mg) 阿替洛尔 ± 苄氟噻嗪 19,257 名 高血压患者 PROBE 设计 ASCOT-BPLA 研究者主导, 国际多中心参与 随机、对照研究 安慰剂 阿托伐他汀 10 mg 双盲 ASCOT-LLA 10,305 患者 TC ≤ 6.5 mmol/L (250 mg/dL) Bjorn Dahlof et al. Lancet 2005;366:895-906 Summary of all end points Amlodipine ? perindopril better Atenolol ? thiazide better 0.50 0.70 1.00 1.45 Primary Non-fatal MI (incl silent) + fatal CHD SecondaryNon-fatal MI (exc. Silent) +fatal CHD Total coronary end pointTotal CV event and proceduresAll-cause mortalityCardiovascular mortalityFatal and non-fatal strokeFatal and non-fatal heart failure 2.00 0.90 (0.79-1.02) 0.87 (0.76-1.00) 0.87 (0.79-0.96) 0.84 (0.78-0.90) 0.89 (0.81-0.99) 0.76 (0.65-0.90) 0.77 (0.66-0.89) 0.84 (0.66-1.05) Unadjusted HR (95% CI) 培哚普利8 mg显著减少心血管疾病死亡率 Bjorn Dahlof et al. Lancet 2005;366:895-906 EUROPA 研究中的培垛普利8mg/日 ------培垛普利8mg/日治疗慢性稳定性冠心病患者的