raas抑制剂在心血管系统应用.pptVIP

* * * * * * * * 心力衰竭 2014中国心力衰竭诊断和治疗指南 HF-REF 收缩性心力衰竭 HF-PEF 舒张性心力衰竭 慢性心力衰竭（2014中国） 慢性HF-REF ACEI ACCF/AHA 2013 Stage B: Prevent 1)a recent or remote history of MI or ACS and reduced EF,(IA) 2)all reduced EF even without MI (IA) stage C:3)HF-REF,current or prior symptoms unless contraindicated (I A) ESH/ESC 2012 in addition to a beta-blocker, for all patients with an EF ≤40%(IA) 中国 2014 所有LVEF下降的心衰患者，必须且终身使用ACEI（IA) ，阶段A人群可考虑用ACEI来预防心衰（IIA）。 慢性HF-REF ARB ACCF/AHA 2013 1)ACEI intolerant(IA),2)alternatives to ACEI as first-line(IIa A), 3) symptomatic patients treated with ACEI and BB but aldosterone antagonist is not indicated or tolerated(IIb A)4) Harm :combined use of ACEI,ARB MRA harmful (IIIC) ESH/ESC 2012 1)EF ≤40% and unable to tolerate an ACE (patients should also receive a beta-blocker and an MRA).(IA) 2)EF ≤40% and persisting symptoms (NYHAclass II–IV) despite treatment with an ACEIand a BB who are unable to tolerate an MRA.(IA) 3）Harm :combined use of ACEI,ARB MRA harmful (IIIC) 中国 2014 同ACEI，不能耐受ACEI（I,A) ，经D,ACEI,BB改善不满意，不能耐受MRA（IIb A）。 慢性HF-REF MRA ACCF/AHA2013 1)LVEF ≤35% 、NYHA II-IV(II CV hosiptalization,BNP) GFR30 and K5mM（I A);2)AMI后、LVEF ≤ 40%,有心衰症状或既往有糖尿病史者（IB)；3)Harm:GFR30 and/or K5mM(IIIB) ESH/ESC 2012 1)alternative to an ACEI or ARB, if neither is tolerated, EF ≤45% and dilated LV (or EF ≤35%). Patients should also receive a BB and an MRA.(IIb B) 2)EF ≤45% and dilated LV (or EF ≤35%) and persisting symptoms (NYHA class II–IV) treatment with BB, ACEI (or ARB), and an MRA (or ARB).(IIb B) ) 中国 2014 所有LVEF ≤ 35%\NYHAII-IV的心衰患者，已使用ACEI(ARB)或BB仍有持续症状的患者（IA);AMI后、LVEF=40%,有心衰症状或既往有糖尿病史者（IB) 慢性HF-PEF ACEI ARB ACCF/AHA 2013 1)The use of beta-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control blood pressure in patients with HFpEF. (IIa C) 2) The use of ARBs might be considered to decrease hospitalizations for patients with HFpEF(IIb B) ESH/ESC 2012 - 中国 2014 伴左心室肥厚者,为逆转左心室肥厚和改善左心室舒张功能，可用ACEI、ARB