ACTION研究高血压亚组结果与分析课件.ppt

ACTION研究高血压亚组结果与分析 ACTION: 设计 ACTION: 分组 ACTION：血压升高患者终点事件 ACTION: 高血压亚组结果 临床意义(一) EUROASPIRE ⅠandⅡ 冠心病合并高血压占冠心病患者51%(37%-64%)。 即使采用兼有降压作用的治疗冠心病药物，即?-阻滞剂和ACEI，仍然有1/2以上患者血压未获得控制。 血压控制达标率 EUROASPIRE Ⅰ(1995-1996): 44% EUROASPIRE Ⅱ(1999-2000): 45% ACTION(高血压亚组)基线时降压药使用情况 ACTION(高血压亚组)：血压控制达标率 Nifedipine GITS reduced add-on therapy in the hypertensive subgroup 临床意义(二) Mortality Due to CHD per Quartile of Usual Systolic and Diastolic BP: Seven Countries Study Hypertensive patients were at high risk of CVD BP-Lowering Treatment Trialists Significant reductions in composite endpoints 临床意义(三) BP-Lowering Treatment TrialistsComparisons of Different Active Treatments BP-Lowering Treatment TrialistsComparisons of Active Treatments and Control Nifedipine GITS prevents new overt heart failure 结 论 ACTION研究确立了硝苯地平控释片(拜新同)在稳定性冠心病患者中的治疗地位，尤其合并血压升高患者，为合理选择抗心绞痛治疗药物提供了证据。 稳定型冠心病临床试验 基线血压水平 SBP(mmHg) HOPE EUROPA QUIET PEACE CAMELOT ACTION(血压不高亚组) 139/79 137/82 123/74 134/78 129/78 122/75 Short acting sublingual or buccal nitrate prn Beta blocker Add dihydropyridine calcium antagonist Symptoms not controlled Heart rate lowering calcium antagonist eg diltiazem/verapamil Level of evidence Long acting nitrate or transdermal nitrate Immediate short term relief Treatment aimed at relief of symptoms Intolerant (eg fatigue) or contraindication Intolerant or ineffective Symptoms not controlled after dose optimisation 1C 1A 1A 1A 1B 1C Guidelines for the management of stable angina The Seven Countries Study Research Group was conducted in 6 geographic regions: the United States, northern Europe, inland and Mediterranean southern Europe, rural Serbia, and Japan. Participants were 12,031 males age 40 to 59 years with no evidence of CHD at the time of enrollment. Baseline BP was measured according to standardized methods. Participants were followed up for 25 years, with add