ARBs在学高血压治疗中的地位.ppt

* * The principal finding of VALUE was that, for the primary composite endpoint of cardiac mortality and morbidity, there were no significant differences in these high-risk patients treated with valsartan- or amlodipine-based regimens.1 This was observed despite significant differences in achieved blood pressures. In a recent meta-regression analysis based on 30 hypertension trials with 149,407 patients, differences in achieved SBP were found to largely account for cardiovascular outcomes.2 1. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with valsartan- or amlodipine-based regimens: VALUE, a randomised trial. Lancet. 2004;363. 2. Staessen JA, Wang JG, Thijs L. Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003. J Hypertens. 2003;21:1055-1076. * In a study led by Kassler-Taub, 532 patients with mild-to-moderate hypertension completed an 8-week, double-blind period in which they received 100 mg losartan, 150 mg irbesartan,300 mg irbesartan, or a placebo. All active treatments reduced BP significantly (p0.001) versus placebo at all time points. A greater antihypertensive effect of irbesartan 300 mg once daily compared with losartan 100 mg once daily was present throughout the study. At Week 8, reductions from baseline in trough seated diastolic BP (SeDBP), the primary endpoint of the trial, were significantly greater with irbesartan 300 mg, compared with losartan 100 mg by 3.0 mmHg (-11.7 vs. -8.7 mmHg; p0.01). The difference in SeDBP between these 2 groups was also statistically significant at Weeks 1 (p0.01) and 4 (p0.02). Irbesartan 150 mg produced overall changes in SeDBP comparable to losartan 100 mg.10 Both drugs were well-tolerated. * Reductions in trough SeSBP at Week 8 were also significantly greater with irbesartan 300 mg, compared with losartan 100 mg (p0.01), by 5.1 mmHg (-16.4 vs. -11.3 mmHg, respectively). Reductions in trough SeSBP