替米沙坦与代谢综合征ppt课件.pptVIP

The Ideal Combination Therapy in Hypertension Effective BP reduction at low doses Sound pathophysiological and pharmacodynamic rational Protection of associated Risk Factor Control of Target Organ Damage Control of events Well tolerated and few side effects Antihypertensive therapy is the most effective preventive measure in diabetes Monotherapy is rarely sufficient Increased rational use of combination therapy is the key to improving blood pressure control The type of drugs used in combination influences the BP lowering effect of the combination, the adverse event profile and may ultimately influence morbidity and mortality Summary I Cardiovascular and Renal Protection With ARBs in Type 2 diabetes and Hypertension IDNT RENAAL New End Points and Guidelines for Diabetes Hypertension Natural History and Progression of Diabetic Nephropathy Preclinical GBM thickening Mesangial remodeling Macroalbuminuria Hypertension Retinopathy/neuropathy CV events ++ Microalbuminuria Endothelial dysfunction HBP Retinopathy/neuropathy CV events + Lowering blood pressure Inhibiting RAAS Early intervention and multifactorial treatment ?Renal function Death ESRD Death IRMA 2 MARVAL GBM = glomerular basement membrane. Cardiovascular event-free survival curves in hypertensives with or without the metabolic syndrome J Am Coll Cardiol 2004;43:1817-22 Presence of Risk Factors (BP, Cholesterol, Smoking, Overweight, IGT or Metabolic Syndrome) Intermediate End Points LVD or CHF (BNP) Clinical Sequelae and Events (AMI, Stroke, ESRD, Death) Vascular (CRP) Inflammation Microalbuminuria Endothelial Dysfunction Carotid Atherosclerosis Chronic Renal Failure LVH Diabetes Mellitus Targets and Goals of Therapy MV 2004 Delayed Progression Prevented Development REGRESSION Central Role of Intermediate End Points and Biomarkers in the Cardiovascular and Renal Continuum New Targets of Therapy PRIMARY PREVENTION Reduce Development of Metabolic Synd