降压治疗研究新动态回顾与展望课件.pptVIP

降压治疗研究新动态 回顾与展望 ◆ 80岁以上高龄高血压 (HYVET) ◆ 高血压前期 (TROPH, PHARAO) ◆ 心房颤动 (ADVANCE post hoc) 新动态(一): 扩展降压治疗获益人群 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0 100 200 300 400 500 600 700 800 900 1000 1100 1200 Days Control Ramipril Survival function PHARAO Study: Primary Endpoint Development of Hypertension Hazard ratio 0.656(0.533-0.807) Luders S, et al. J Hypertens. 2008;26:1487-1496 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 60 40 20 0 90 100 120 130 140 160 170 180 190 200 220 230 240 Prehypertension Uncertainty Range ~ 55 – 75% of the general population % of screened population Normotension Prehypertension Masked Hypertension Sustained Hypertension Mixed population with White Coat Hypertension and Sustained Hypertension (FPs TPs) Masked Hypertension (office BP 140/90 mmHg) (FNs) ADVANCE-AF 研究 11140例2型糖尿病，心房颤动占7.6%。 perindopril / indapamide 降压治疗4.3 年， 治疗组血压比对照组降低 5.3 / 2.3 mmHg。 心房颤动患者降压治疗后总死亡率与心 血管死亡率分别降低14%与18%，NTT 42。 Eur Heart J. 2009; March 12. online publication. The ACTIVE Steering Committee. Am Heart J. 2006; 151:1187-93 Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events ◆ 脑卒中史 (PROGRESS再分析, WASID) ◆ 糖尿病 (ADVANCE) 新动态(二): 心血管高危患者强化血压控制 100 80 60 40 20 0 120 120-139 140-159 ?60 100 80 60 40 20 0 70 70-79 80-89 ?90 Achieved systolic blood pressure levels (mmHg) Achieved diastolic blood pressure levels (mmHg) Age-and sex-adjusted incidence rate CKD: P trend=0.004 Non-CKD: P trend0.0001 CKD: P trend=0.001 Non-CKD: P trend0.0001 CKD Non-CKD Incidence rate (1000 person-years) PROGRESS - CKD Substudy: SBP and CVD WASID Trial (Warfarin-Aspirin Symtomatic Intracranial Disease) Relationship Between Blood Pressure and Strke Recurrence in Patients With Intracranial Arterial Stenosis Turan TN, et al.Circulation.2007;115:2969-2975 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 0 1 2 3 4 5 Follow-up (yrs) P0.0001