老年高血压患者 RAAS特点分析及其治疗对策.pptxVIP

老年高血压患者RAAS特点分析及其治疗对策;RAAS名称使用的注意事项;;RAAS中血管紧张素Ⅱ和醛固酮 是发挥生物作用的效应分子;健康人肾脏随年龄增长结构发生多重改变体积越来越小，硬化程度加重;老年肾脏的多方面功能改变;正常血压老年人肾素活性下降至青年人的一半;然而，老年高血压患者肾素活性却增加Plasma Renin Activity Levels in Hypertensive Persons: Their WideRange and Lack of Suppression in Diabetic and in Most Elderly PatientsN=4170;;ARB良好的降压疗效;ESH/ESC 2013 ARB类药物优先适用的情况，尤其是肾脏保护作用;JNC8强调的健康终点第一次包括肾脏;;14;终末期肾病的发病率（1982-1995）;JNC8强调RASI改善肾脏结局的重要性;11. Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. Lewis EJ, Hunsicker LG, ClarkeWR, et al; N Engl J Med. 2001;345(12):851-860.;厄贝沙坦显著降低一级终点 20%与安慰剂(P=0.02) 23%与氨氯地平(P=0.006);11. Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. Lewis EJ, Hunsicker LG, ClarkeWR, et al; N Engl J Med. 2001;345(12):851-860.;指南推荐厄贝沙坦RCT靶剂量为300mg;JNC8 引用的降低肾终点事件的RCT;;Effect of Renin–Angiotensin System Inhibition on Cardiovascular Events in Older Hypertensive Patients with Metabolic Syndrome;RAS抑制剂在老年高血压治疗中的重要地位及注意事项;The only trial directly comparing two combinations in all patients (ACCOMPLISH) found significant superiority of an ACE inhibitor-calcium antagonist combination over the ACE inhibitor-diuretic combination despite there being no BP difference between the two arms. These unexpected results deserve to be repeated, because trials comparing a calcium antagonist-based therapy with a diuretic-based therapy have never shown superiority of the calcium antagonist. ;15. 孙宁玲主编 .高血压治疗学.北京;人民卫生出版社:2009;;Robert Petrella, et al, Clinical Therapeutics 2011;33(9):1190-1203;对利尿剂的过多担心：利尿剂相关的糖代谢 异常与大剂量利尿剂引起的低血钾有关;厄贝沙坦150mg+HCTZ12.5mg 对血钾的影响0.1mEq/L;总 结