钙拮抗剂降压治疗地位进展.ppt
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1、钙拮抗剂降压治疗地位进展 从循证证据和国际治疗指南的角度,影响不同种类降压药物治疗地位的决定因素, 禁忌症 循证医学证据 不良反应和治疗持续性 效益/费用 种族,各类降压药物的禁忌症(ESC/ESH,2007),噻嗪类利尿剂 痛风 代谢综合症、糖耐量减低 妊娠 -阻滞剂 哮喘、 外周血管病、代谢综合症 糖耐量异常、慢阻肺 A-V阻滞(2或3度) 运动员和强体力活动者 二氢吡啶类CCB 快速性心律失常、心力衰竭 非二氢吡啶类CCB A-V阻滞(2或3度) 心力衰竭 ACEI和ARB 妊娠、高血钾症 双侧肾动脉狭窄 醛固酮拮抗剂 肾功能衰竭 高血钾症,绝对(强制) 相对(可能),SBP diffe
2、rence between randomized groups (mmHg),Relative risk of outcome event,BP-Lowering Treatment Trialists (WHO/ISH, 2003),Blood Pressure Lowering Treatment Trialists Collaboration. Lancet. 2003;362:1527-1535.,0.5,1.0,2.0,Relative Risk,RR (95% CI),BP Difference (mm Hg),Favors First Listed,Favors Second L
3、isted,Major CV events,CV mortality,Total 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,
4、1.13),1/1,ACEI vs CA,1.04 (0.98, 1.10),1/1,ACEI vs CA,Blood Pressure Lowering Treatment Trialists Collaboration. Lancet. 2003;362:1527-1535.,BP-Lowering Treatment Trialists Comparisons of Different Active Treatments,RR (95% CI),Favours first listed,Favours second listed,0.5,1.0,2.0,Relative Risk,BP
5、difference (mm Hg),1.09 (1.00,1.18),ACEI vs. D/BB,0.93 (0.86,1.01),CA vs. D/BB,1.12 (1.01,1.25),ACEI vs. CA,2/0,1/0,1/1,BPLTT (2003): Stroke Comparisons of different active treatments,Blood Pressure Lowering Treatment Trialists Collaboration. Lancet. 2003;362:1527-1535.,0.2,1.8,2.0,15,10,5,-5,Odds r
6、atio for CHD,ACE Is,Systolic BP difference between groups (mmHg),Verdecchia et al 2005,0,Relationship Between Odds Ratio for CHD and Achieved BP Differences,CCBs and CV Outcomes New Meta-Analysis (ACC, 2009),在BPLTT的基础上,纳入了2003年以后发表的临床试验: ACTION, ASCOT-BPLA, CAMELOT, CASE-J, FEVER, INVEST, MOSES, HIC
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- 关 键 词:
- 拮抗剂 降压 治疗 地位 进展
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