高血压与降压治疗策略-中国高血压防治指南解读演示文稿.ppt

优化降压联合治疗方案 DHP-CCB + ACEI/ARB ★ ★ ★ (ASCOT, ACCOMPLISH) DHP-CCB + βblocker ★ ★ (HOT, INSIGHT, ALLHAT) ACEI/ARB + Diuretics ★ ★ (LIFE, VALUE, ACCOMPLISH) DHP-CCB + Diuretics ★ ★ (VALUE, FEVER) ACEI/ARB + β blocker ★ (ALLHAT) β blocker + Diuretics ★ (LIFE, ASCOT, INSIGHT) ACEI + ARB ─ (ONTARGET) INSIGHT：糖尿病患者终点事件 患者百分数(%) 0.0 4.0 8.0 Co-amilozide 12.0 p = 0.03 14.2 Nifedipine GITS 16.0 20.0 18.7 Mancia G, et al. Hypertension 2003;41:431–6. 所有主要终点,非心脑血管性死亡,ESRD,心绞痛和短暂性脑缺血 Co-amilozide Nifedipine GITS INSIGHT serious and metabolic adverse events Serious adverse events 0% 5% 10% 15% 20% 25% 30% 0% 2% 4% 6% 8% 10% Nifedipine GITS Co-amilozide Hypokalaemia p=0.02 p0.0001 Hyponatraemia Hyperlipidaemia Hyperglycaemia Impaired renal function Hyperuricaemia p0.0001 p0.0001 p=0.001 p0.0001 p0.0001 Brown M, et al. Lancet 2000;356:366–72. 176 (5.6%) INSIGHT: 对新发糖尿病的影响 Nifedipine GITS 0 20 40 60 80 100 120 140 160 180 Co-amilozide 136 (4.3%) p=0.023 Patients with newly diagnosed diabetes mellitus (n) Mancia G, et al. Hypertension 2003;41:431–6. （氨氯地平+/-培哚普利 Vs. 阿替洛尔+/-苄氟噻嗪） *P0.05 降低百分比 (%) -35 -30 -25 -20 -15 -10 -5 0 * * * * * * * 非致死心梗 和冠心病死亡 心血管 死亡 总死亡 总冠脉事件 致死/ 非致死性 卒中 总心血管 事件和 介入 新发 糖尿病 肾损害 Dahlof B, Sever P, et al. Lancet. 2005;366:895-906. ASCOT-BPLA:终点事件发生率 Cumulative event rate HR (95% CI) 0.80 (0.72, 0.90) 20% Risk Reduction Time to 1st CV morbidity/mortality (days) p = 0 ACEI / HCTZ CCB / ACEI 650 526 .0 0 0 2 ACCOMPLISH: 主要终点 中国高血压人群的临床特点 最主要的心血管危险是脑卒中 高血压发生和血压水平与摄盐量或饮食钠/钾比值较高密切有关 老年人占的比例很高 约定1/10男性患者有嗜酒行为 脑卒中与心肌梗死的比值 不同临床试验比较 STONE 8.0 Syst-China 8.7 NICS-EH 4.0 SHEP 1.2 MRC II 0.8 STOP-H 1.2 Syst-Eur 1.7 ACTION: Events in Patients with Hypertension vs ISH Primary Endpoint – Efficacy Primary Endpoint – safety Any CV Event Death, any CV Event or Revascularisation Any Vascular Event or Revascularisation 0.65 1 1.3 HR (95% CI) Elliott Meredith, 2009 Favours