高血压患者他汀治疗的临床思考-(社区).pptVIP

降压+他汀高血压合并危险因素患者抗AS治疗的解决之道，他汀是治本 内皮功能紊乱、氧化反应、炎症反应 脑卒中 心绞痛、心梗 高血压、高胆固醇、吸烟、家族史、年龄增加、肥胖、高血糖、体力活动不足 危险因素 他汀 降压 临床践行的成功案例：英国550万高血压患者他汀处方比例增加，心血管获益显著 35% 心血管病 死亡率 毫无疑问，降压基础上联合他汀是实现更多心血管保护的有效途径。 他汀应该、而且将会成为高血压患者的常规治疗。 ——Dr. Bryan Williams（英国高血压学会指南委员会主席） 谢 谢！ * The primary endpoint occurred in 171/3429 (5.0%) patients in the 10 mm Hg range 140 and 179/2354 (7.6%) patients 140 mm Hg; hazard ratio (HR) = 0.62, p = 0.0001. Similarly, CV death fell by 36% (p = 0.0147), total MI by 37% (p = 0.0028), and stroke by 47% (P = 0.0002). CV event rates in the range 130 were not different from 140 mm Hg. However, compared with 130, stroke in the range 120 mm Hg was lower: HR= 0.60, p = 0.0529; but MI was higher: HR= 1.52, p = 0.0437; as were composite coronary events (MI or hospitalized angina or sudden death): HR= 1.63, p = 0.0023. Overall: achieving a systolic BP 140 mm Hg provides superior outcomes to 140 mm Hg while achieving a systolic BP 130 mm Hg is similar to 140 mm Hg. Achieving a systolic BP 120 mm Hg provides better stroke protection than 130 mm Hg, but there is an increase in coronary events such that stroke events are reduced by 2.9 events (per 1000 patient years) and coronary events are increased by 5.7 events (per 1000 patient years). Thus, the cost of preventing 1 stroke is 2 coronary events. Weber et al. concluded that in high-risk middle-aged and older hypertensive patients, optimal protection against CV, stroke, and renal events appears to exist at SBPs in the range 130-139 mm Hg, perhaps best at around 130 mm Hg * * 英国人向来以“保守”闻名于世，为什么在他汀的使用上比其他国家都“大胆”呢？ 原因就在于“ASCOT研究”，英国是该研究的重要的参与国之一。 ASCOT研究是一项多中心、前瞻性、随机、开放、盲终点对照研究，共入选19257名40-79岁的高血压患者，在严格降压的基础上，随机联合阿托伐他汀10mg/日或安慰剂治疗。由于出乎预料的好结果，研究的2个分支都提前结束。 下面，我们来看一下降脂分支的结果。 A total of 719 centers participated in ASCOT, including 686 general practices in Denmark, Finland, Iceland, Norway, and Sweden and 33 regi