高血压地治疗：新地循环医学证据.pptVIP

高血压治疗新的循证医学证据 华中科技大学协和医院心内科 廖玉华 高血压治疗：新的循证医学证据 ADVANCE研究 — 固定复方制剂 VALIDD研究 — 降压与心室舒张功能 A meta-analysis of RCTs 中国人高血压临床试验证据 ADVANCE研究: 在11,140例2型糖尿病患者中进行的降压与强化血糖控制的析因随机临床试验 Inclusion criteria Type 2 diabetes mellitus Age 55 years or older Additional risk of vascular event Age ? 65 years History of major macrovascular disease History of major microvascular disease First diagnosis of diabetes 10 years prior to entry Other major risk factor Hypertensive or normotensive Randomised study treatments Blood pressure lowering Double-blind perindopril-indapamide versus matching placebo 2.0 / 0.625mg or placebo for first 3 months 4.0 / 1.25mg or placebo thereafter Blood glucose lowering (ongoing) Open-label gliclazide MR-based intensive therapy targeting an HbA1c of 6.5% versus usual guideline-based care ADVANCE study hypothesesPerindopril-indapamide arm Among patients with diabetes, does blood pressure lowering therapy: Produce additional benefits when systolic pressure is lowered below 145 mmHg? Produce similar benefits for hypertensive and non-hypertensive patients? Add to the benefits produced by other cardiovascular preventive therapies including ACE inhibitors? ADVANCETrial profile 血压降低情况 全因死亡率 死亡分析 Coronary events Cerebrovascular events Renal events 常规使用培哚普利与吲达帕胺的绝对获益 总结 2型糖尿病患者常规使用培哚普利/吲达帕胺治疗的结果: 总死亡率降低14% 心血管死亡降低18% 主要血管事件降低9% 总冠脉事件降低14% 总肾脏事件降低21% Blood pressure lowering in diabetes: Unresolved issues 2000 Among patients with diabetes, does blood pressure lowering therapy: Produce additional benefits when systolic pressure is lowered below 145 mmHg? Produce similar benefits for hypertensive and non-hypertensive patients? Add to the benefits produced by other cardiovascular preventive therapies including ACE inhibitors? VALIDD研究 研究目的 目的:验证下列假说是否正确 “ARB较其他非阻断RAAS系统的降压药物更有效改善左室舒张功能” 研究设计 ARB vs. 非RAAS阻断剂组:降压幅度相当 38周后,两组的血压较基线相比降低幅度没有显著差异 ARB vs. 非RAAS阻断剂组:改善舒张功能疗效相当 38周后,ARB和非RAAS阻断类降压药物均显著改善舒张功能，疗效相当 研究结论 轻中度高血压患者虽然左室肥厚发生率低，但已经存在心肌舒张功能不全，这是高血压靶器官受累的早