复旦内科新理论新技术高血压治疗.pptVIP

* * * * The LIFE study primary endpoint was a composite of cardiovascular mortality, fatal and non-fatal myocardial infarction, and fatal and non-fatal stroke. Other predefined endpoints included total mortality, angina pectoris, heart failure, revascularization, resuscitated cardiac arrest, and new-onset diabetes mellitus. Patients who experienced more than one endpoint were counted in all relevant categories; however, where multiple endpoint events occurred in patients, only the first event was counted in the endpoint component analyses. For the losartan compared to atenolol treatment group, there was a 13% adjusted relative risk reduction for the primary composite endpoint (P=0.021). * * * Relationship Between SBP Reduction and CV Mortality In this slide we see a meta-analysis of a large number of outcomes studies performed in hypertensive patients. This clearly demonstrates that reducing systolic BP decreases cardiovascular mortality and confirms that the greater the reduction in systolic BP, the greater the cardiovascular benefit. ? Reference: Staessen JA, et. al. Cardiovascular Protection and Blood Pressure Reduction: a Meta-analysis. Lancet 2001;358:1305-1315. * HOT Trial: Cardiovascular Events in Diabetics and Nondiabetics—Effect of Diastolic Target at 4 Years In patients without diabetes mellitus in the HOT Trial, there was no difference in the cardiovascular event rate at 4 years regardless of the diastolic blood pressure achieved, whereas in patients with diabetes mellitus, the lower the diastolic blood pressure the lower the risk of cardiovascular events. These data suggest that as blood pressure is lowered more aggressively in patient with diabetes, the additional medications required, such as ACE inhibitors, may provide a benefit in risk reduction beyond blood pressure lowering itself. This effect may not be apparent in patients without diabetes. Reference: Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard