1、n降压治疗的主要益降压治疗的主要益处在于血压下降本处在于血压下降本身身n降压治疗的主要目降压治疗的主要目标为最大程度地降标为最大程度地降低长期心血管疾病低长期心血管疾病发病率及死亡率的发病率及死亡率的总体风险总体风险n简单的治疗有助于提高患者依从性20072007降压达标是减少心脑血管事件的基础平均的降压药物数量平均的降压药物数量1 12 23 34 4Trial(SBP achieved)Trial(SBP achieved)Reproduced from Am J Med 116(5A),Bakris et al.pp.30S8.Copyright 2004,with permission
2、 from Elsevier;Dahlf et al.Lancet 2005;366:895906ASCOT-BPLA(136.9 mmHg)ASCOT-BPLA(136.9 mmHg)ALLHAT(138 mmHg)ALLHAT(138 mmHg)IDNT(138 mmHg)IDNT(138 mmHg)RENAAL(141 mmHg)RENAAL(141 mmHg)UKPDS(144 mmHg)UKPDS(144 mmHg)ABCD(132 mmHg)ABCD(132 mmHg)MDRD(132 mmHg)MDRD(132 mmHg)HOT(138 mmHg)HOT(138 mmHg)AAS
3、K(128 mmHg)AASK(128 mmHg)需要联合用药方案需要联合用药方案联合用药是提高达标率的关键Journal of Hypertension 2007,25:11051187.20072007Journal of Hypertension 2007,25:11051187.2007ESC/ESH高血压指南ESC/ESH 2007EX-FAST:J Clin Hypentens,2008,3Kenneth JamersonKenneth Jamerson1 1,George L.Bakris,George L.Bakris2 2,Bjorn Dahlof,Bjorn Dahlof3
4、 3,Bertram Pitt,Bertram Pitt1 1,Eric J.VelazquezEric J.Velazquez4 4,and Michael A.Weber,and Michael A.Weber5 5 for the ACCOMPLISH Investigatorsfor the ACCOMPLISH InvestigatorsUniversity of Michigan Health System,Ann Arbor,MIUniversity of Michigan Health System,Ann Arbor,MI1 1;University of Chicago-P
5、ritzker School of Medicine,Chicago,IL;University of Chicago-Pritzker School of Medicine,Chicago,IL2 2;Sahlgrenska;Sahlgrenska University Hospital,Gothenburg,SwedenUniversity Hospital,Gothenburg,Sweden3 3;Duke University School of Medicine,Durham,NC;Duke University School of Medicine,Durham,NC4 4;SUN
6、Y Downstate Medical College,;SUNY Downstate Medical College,Brooklyn,NYBrooklyn,NY5 5 ACCOMPLISH:ACCOMPLISH:研究设计研究设计Jamerson KA et al.Am J Hypertens.2003;16(part2)193ATitrated to achieve BP140/90 mmHg;130/80 Titrated to achieve BP140/90 mmHg;130/80 mmHg in patients with diabetes or renal mmHg in pat
7、ients with diabetes or renal insufficiencyinsufficiencyN=11446基线基线控制率控制率37.237.9ACCOMPLISH:起始为联合治疗的控制率ACEI/HCTZACEI/HCTZN=5733N=5733控制率控制率(%)(%)CCB/ACEICCB/ACEIN=5713N=571310102020303040405050606070708080909078.581.7P0.001 P0.001 随访随访3030月时月时对照组为 140/90 mmHg“强化”降压是否已经足够？Journal of Hypertension 2007,
8、25:11051187.ONTARGET/TRANSCEND Investigators.Am Heart J.2004;148:52-61.*n=7800n=7800n=7800n=7800n=7800n=7800*Planned.Actual=25,620ONTARGET：Years of Follow-upCumulative Hazard Rates0.00.050.100.150.200.2501234RamiprilTel.&Ram.#at Risk Yr 1Yr 2Yr 3Yr 4R85768214783274737095T&R85028134774073777023 ACEI+
9、ARB的组合并未进一步减少事件，相反还会增加不良反应的发生 A+C或A+D是否优化的联合降压策略？ACCOMPLISHACCOMPLISH:冠脉重建术冠脉重建术(Intent-to-treat population)(Intent-to-treat population)Favors Favors CCB/ACEICCB/ACEIFavors Favors ACEI/HCTZACEI/HCTZ中期数据 Mar 08ASCOTASCOT：Includes patients receiving beta blockers,alpha blockers,clonidine,loop diuretic
10、s.The number of patients with free Includes patients receiving beta blockers,alpha blockers,clonidine,loop diuretics.The number of patients with free add-on antihypertensive agents only include those patients who has reached dose level 3.add-on antihypertensive agents only include those patients who
11、 has reached dose level 3.ACEI/HCTZACEI/HCTZN=5733CCB/ACEICCB/ACEIN=5713At 30 month follow-upAt 30 month follow-upStudy Medication OnlyStudy+1 Add-onStudy+2 Add-onDrug InterruptionStudy Medication OnlyStudy+1 Add-onStudy+2 Add-onDrug InterruptionTHANK YOU FOR THANK YOU FOR YOUR ATTENTIONYOUR ATTENTION
