高血压合并血脂异常的治疗PPT课件.ppt

*那么，高血压患者采取什么样的治疗方案呢？这项荟萃研究比较了各种治疗方案所带来的心血管获益：如图所示，降压药治疗使CV风险降低46%、他汀治疗使风险降低61%、阿司匹林治疗使风险降低32%，叶酸也实现16%的降低；于是作者大胆的提出一个设想，将4种药做成一种复方制剂(polypill)，实现获益的最大化，那么将实现88%的获益。当然，这仅仅是一种假想。而从图中，我们可以看到，他汀所带来心血管获益是最显著的；而将降压药和他汀联合，将实现更多的心血管保护。*1.比较?-阻滞剂(阿替洛尔)?利尿剂(苄氟噻嗪钾)和CCB(氨氯地平)?ACE(培朵普利)对非致死性心肌梗死和致死性冠心病的作用;2.比较在TC?6.5mmol/L(?250mg/dL)的高血压患者他汀（阿托伐他汀）与安慰剂相比对非致死性心肌梗死和致死性冠心病联合终点的作用References1. Dahl?fB,SeverPS,PPoulterNR,etalfortheASCOTInvestigators.Preventionofcardiovasculareventswithanantihypertensiveregimenof氨氯地平adding培哚普利asrequiredversus阿替洛尔adding苄氟噻嗪asrequired,intheAnglo-ScandinavianCardiacOutcomesTrial-BloodPressureLoweringArm(ASCOT-BPLA):amulticentrerandomisedcontrolledtrial.Lancet.2005;366:895-906.2. SeverPS,Dahl?fB,PoulterNR,etal,fortheASCOTInvestigators.Preventionofcoronaryandstrokeeventswith阿托伐他汀inhypertensivepatientswhohaveaverageorlower-than-averagecholesterolconcentrations,intheAnglo-ScandinavianCardiacOutcomesTrialLipidLoweringArm(ASCOT-LLA):amulticentrerandomisedcontrolledtrial.Lancet.2003;361:1149-1158.3. SeverPS,Dahl?fB,PoulterNR,etal,fortheASCOTinvestigators.Rationale,design,methodsandbaselinedemographyofparticipantsoftheAnglo-ScandinavianCardiacOutcomesTrial.JHypertens.2001;19:1139-1147.*Bloodpressurecontrolthroughoutthetrialwasverysimilarinthegroupsrandomisedtoatorvastatinandplacebo.Meanlevelsatbaselinewere164/95andatclose-outwere138/80forbothgroups.*TheprimaryendpointofnonfatalMI(includingsilentMI)andfatalCHDwassignificantlylowerby36%(hazardratio0.64,CI0.5–0.83,p=0.005)intheatorvastatingroupcomparedwiththeplacebogroup.*Thesecondaryendpointoffatalandnonfatalstrokewassignificantlyloweredby27%(hazardratio0.73,CI0.56–0.96,p=0.0236)intheatorvastatingroupcomparedwiththeplacebogroup.*90年代初MacMahon等对80年代17个相关的随机、对照降压治疗临床试验进行了