基于临床试验高血压治疗策略

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1、HypertensionTreatmentStrategyBasedonClinicalTrialsLiuLishengIsantihypertensivetreatmentbeneficial?Trialsofactivetreatmentvs.placebo(ormorevs.less)Whenshoulddrugtreatmentstart?(BPlevel?Mildhypertension?Riskstratifications?)Whomshouldbetreated?(Severe,mild,ISH)T

2、owhatextent?IsBPloweringbydifferentantihypertensiveagentsequallybeneficial?NecessityofConductingLarge-scaleClinicalStudiesusingAsianSubjectsTrialsYearContributionsVATrialTheVACooperativeStudyonAntihypertensionDrugs1967SevereHTshouldbetreatedHDFPTheHTDetectionan

3、dFollow-upProgram(Australia)1976Large-scaleCTcouldbeconductedwell&successfullyincommunityANBPSAustralianNationalBPStudy1979A4-monthobservationperiodisadvisablebeforeinstitutingdrugtreatmentMRCtrialTheMRCTrialofTreatmentinMildHT(British)1977Absolutebenefitsweres

4、mallinmildHT,treat850ptssave1strokeMildHT,aweakclaimforstatusasanentityTrialsYearContributionsBHAT-blockerHeartAttackTrial1981CHDcouldbereducedinPOST-MIpts.by-blockerEWPHETheEuropeanworkingPartyonHighBPintheElderly1984ElderlyHTpts.wouldbenefitfromantiHTtreatm

5、entMRCELDERLYTRIALMedicalResearchCouncilTrialofTreatmentofHTinOlderAdults1987demonstratedasignificantreductioninstroke,cardiacandallCVDeventsSTOP-HTTheSwedishTrialinOldPats.withHT1991DrugtreatmentinHTpts.70-84reduceCVDmorbidity&mortality&totalmortalityTrialsYea

6、rContributionsSHEPSystolicHTintheElderlyReducedTotalStrokeandallCHD1991SystolicHTintheelderly,ISHshouldbetreatedinolderpts.VAstudyonMonotherapy1990HCHZgreatlyenhancedtheefficacyofnon-diureticdrugs,HCTZ12.5mgCDNCaptoprilinType1DiabeticNephropathy1992Captoprilcan

7、reduceprogressionofrenaldiseaseimprovedsurvivalDoublingofSerumCr.EndpointSyst.-ChinaChneseSystolicHTintheElderlyTrial1992Totalmortality,CVDmortality&StrokemortalityreducedbyCCBbasedtreatmentTrialsYearContributionsTOMHSStudyTheTreatmentofMildHTStudy1993Combinedl

8、ifestyle/druginterventioninstageIHTisbeneficialPATsPostStrokeAntiHTTreatmentStudy1993BPreductioninpoststrokepts.isbeneficial,eveninnormotensiveSyst.-Eur.Syst.-Eur.Multicentr