从近期大型临床试验看高血压治疗的策略.pptxVIP

从近期大型临床试验看高血压治疗的策略第1页/共61页 第2页/共61页 第3页/共61页 中国人群高血压患病率（％） 年 年龄 样本数 高血压 △（%） 患病率1959 15 500,000 5.1 1980 15 4,000,000 7.7 ↑ 411991 15 900,000 12.6 ↑ 542002 18 270,000 18.8 ↑ 31第4页/共61页 中国高血压知晓率、治疗率和控制率（％） 知晓率 治疗率 控制率* 1991 26.3 17.1 4.1 2002 30.2 24.7 6.1 美国2000 70 59 34 *SBP140mmHg 和 DBP90mmHg第5页/共61页 IHD＝Ischemic Heart DiseaseProspective Studies Collaboration. Lancet. 2002;360:1903-1913.收缩压舒张压Usual Diastolic BP (mm Hg)50-59 years60-69 years70-79 years80-89 yearsAge at risk:40-49 years25612864321684210809010011070IHD Mortality(Floating Absolute Risk and 95% CI)Usual Systolic BP (mm Hg)50-59 years60-69 years70-79 years80-89 yearsAge at risk:40-49 years25612864321684210120140160180血压、年龄与冠心病死亡率(100万人群资料分析)第6页/共61页 降压治疗临床试验荟萃分析结果T = treatmentC = controlNon-fatal eventsFatal eventsTCTCTCTCNumbers individuals020040060080010001200% reductionin oddsStroke39%CHD16%Vascular deaths21%All other deaths2%第7页/共61页 Blood Pressure Lowering Treatment Trialists’ CollaborationBPLTC协作研究Second cycle of overview analyses（2003）InstituteforInternationalHealth第8页/共61页 广泛的病人群和代表性纳入162341病人平均年龄65岁，52％男性平均随访2－8年共随访超过700000病人年BPLTC协作研究:前瞻性 荟萃分析第9页/共61页 0.51.02.0Relative Risk RR (95% CI)BP Difference(mm Hg)FavorsFirst ListedFavorsSecond ListedMajor CV eventsCV mortalityTotal mortality 1.02 (0.98, 1.07)2/0 ACEI vs D/BB 1.03 (0.95, 1.11)2/0 ACEI vs D/BB 1.00 (0.95, 1.05)2/0 ACEI vs D/BB 1.04 (0.99, 1.08)1/0 CA vs D/BB 1.05 (0.97, 1.13)1/0 CA vs D/BB 0.99 (0.95, 1.04)1/0 CA vs D/BB 0.97 (0.92, 1.03)1/1 ACEI vs CA 1.03 (0.94, 1.13)1/1 ACEI vs CA 1.04 (0.98, 1.10)1/1 ACEI vs CABlood Pressure Lowering Treatment Trialists’ Collaboration. Lancet. 2003;362:1527-1535.BP-Lowering Treatment TrialistsComparisons of Different Active Treatments第10页/共61页 CORONARY HEART DISEASEComparisons of different active treatments RR (95% CI) Favo