2007欧洲高血压指南解读课件.ppt

* 这张图显示了高血压患者口服可力洛8mg后的血浆药物浓度和平均血压的变迁。 从图上可以看出，可力洛服用后2小时，血中药物浓度达峰值，7小时后药物浓度减少到能检测到的极限。 但是，血中的药物消失以后，可力洛仍能持续24小时发挥其降压作用。 可力洛不依赖血中的药物浓度，而是通过其特有的Membrane Approach作用机理，发挥其平缓，确切持续的降压作用的。 * ［概　要］ ?2型糖尿病早期肾病患者服用Coniel 3年。表明Coniel 抑制尿微量白蛋白的增加，有效预防糖尿病早期肾病的进展。 ［内　容］ ＜方　法＞ ?２型糖尿病早期肾病患者15例服用４～８mg/日，持续3年。将与服用Coniel 组患者有相同背景的患者15例设定为对照组。 ＜结　果＞ ?对照组患者经过数月或者数年后，尿微量白蛋白显著增加。 ?与对照组相比，Coniel 服药组尿微量白蛋白的增加得到显著抑制。而且，Coniel 显著降低平均血压。 ［总结］ ?Coniel 对２型糖尿病早期肾病患者有确切的降压作用，同时抑制早期肾病进展。 贝尼地平可抑制2型糖尿病早期肾病患者尿中白蛋白排泄量的增加 1405名患者，II级预防患者 ARB 依普罗沙坦 VS 尼群地平，随访2.5年 降压幅度一致 ARB组总脑血管事件比CCB组减少25% * ABCD研究中对于糖尿病的患者进行依那普利或尼索地平的强化降压治疗可明显降低5年时的脑卒中的风险。可见对于糖尿病的患者更低的目标血压获益更大。 * VALUE研究[4]显示，尽早和有效的控制血压可以增加患者的获益。 * * ALLHAT研究的4年结果显示多沙唑嗪与氯噻酮相比明显增加心衰和脑卒中风险 Context? Hypertension is associated with a significantly increased risk of morbidity and mortality. Only diuretics and -blockers have been shown to reduce this risk in long-term clinical trials. Whether newer antihypertensive agents reduce the incidence of cardiovascular disease (CVD) is unknown. Objective? To compare the effect of doxazosin, an -blocker, with chlorthalidone, a diuretic, on incidence of CVD in patients with hypertension as part of a study of 4 types of antihypertensive drugs: chlorthalidone, doxazosin, amlodipine, and lisinopril. Design? Randomized, double-blind, active-controlled clinical trial, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, initiated in February 1994. In January 2000, after an interim analysis, an independent data review committee recommended discontinuing the doxazosin treatment arm based on comparisons with chlorthalidone. Therefore, outcomes data presented herein reflect follow-up through December 1999. Setting? A total of 625 centers in the United States and Canada. Participants? A total of 24,335 patients (aged 55 years) with hypertension and at least 1 other coronary heart disease (CHD) risk factor who received either doxazosin or chlorthalidone. Interventions? Participants were rand