高血压、冠心病最新循证医学结果及临床意义.ppt

ASCOT-BPLA ：Preliminary results favor strategy with newer agents －－ 2005 ACC 全因死亡 非致死性MI / 致死性CHD 总冠脉事件终点： 包括非致死性MI/致死性CHD，新发心绞痛，致死/非致死性心衰 所有心血管事件和操作 致死/非致死性脑卒中 心血管死亡 14% 10% 14% 23% 16% 24% 氨氯地平组与阿替洛尔组相比 新发糖尿病 32% P=0.005 P=0.0048 P=0.0007 P<0.0001 P=0.0017 P值 P<0.0001 P=0.12* * 与试验提前结束，事件数未达到1150例有关 上述终点结果差别的可能解释 氨氯地平/培哚普利组更优秀的血压控制作用 阿替洛尔/噻嗪类利尿剂与他汀之间的不利相互作用 氨氯地平/培哚普利与他汀之间的有利相互作用 氨氯地平/培哚普利降压以外的有益作用 阿替洛尔/噻嗪类利尿剂降压以外的不利作用 AVALON study Arterial wall compliance, percent change from baseline to week 8 (667 patients with hypertension and high LDL) Size of artery  Combination  Amlodipine  Atorvastatin  Placebo  Large (%)  10.2** 10.1* -1.7 3.3 Small (%)  19.6* 11.6*** 2.2 -2.1 *p<0.0001 vs baseline. **p=0.0002 vs baseline. ***p=0.0011 vs baseline. American Society of Hypertension 20th Annual Scientific Session Blood-pressure control was better early on with amlodipine/perindopril. Although levels were virtually identical by the end of the trial, the mean difference was 2.9/1.8 mm Hg through the course of the study. 氨氯地平/培哚普利组血压控制在早期更好，虽然试验结束时两组血压一致，但整个试验过程中两组血压的平均差异达到2.9/1.8mmHg。 Dr Bj?rn Dah?f (Sahlgrenska University Hospital, Oslo, Norway) the ASCOT results reinforce an earlier lesson from the VALUE study, that in complex patients such as those in ASCOT, a calcium antagonist should be part of the antihypertensive cocktail. In VALUE, as in ASCOT, blood-pressure control was achieved more promptly with amlodipine. ASCOT研究结果再一次强化了先前VALUE研究的结论，那就是对于象ASCOT研究中的高危患者，钙拮抗剂应该是抗高血压方案中的组成部分。正如ASCOT一样，在VALUE研究中，氨氯地平组血压得到了更加积极的控制。 Dr Franz H Messerli (St Luke's-Roosevelt Hospital, New York, NY) A calcium antagonist, together with an ACE inhibitor if needed, allows for better blood-pressure control, fewer side effects such as new-onset diabetes, less add-on medication for better persistence with antihypertensive therapy, and last but not least, a greater reduction in morbidity and mortality than with beta blockers and diuretics. 钙拮抗剂，必要时加上ACEI，比beta阻滞剂和利尿剂血压控制效果更好，