高血压和冠心病：治疗策略和指南PPT课件.ppt

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1、HypertensionandCoronaryArteryDisease:ManagementStrategiesandGuidelinesC.RichardContiM.D.MACCGWICC2004BeijingPRCMorbidityandMortalityinContemporaryCADPatientsWithHypertensionTreatedWithEitheraVerapamil/TrandolaprilorBeta-Blocker/DiureticStrategyC.RichardContiMD,MACC,DivisionofCardiovascularMedicin

2、eUniversityofFloridaCollegeofMedicineGainesville,FloridaUSADesignProspective,randomized,opentrialwithblindedendpointevaluation(PROBE)toassessoutcomes(death,MI,stroke)inhypertensiveCADpatientstreatedwitheitheracalciumantagonistbased(verapamilSR)ornoncalciumantagonistbased(atenolol)treatmentstrateg

3、yHypothesisTreatmentstrategiesareequivalent(CI0.83,1.20)BPGoalsAccordingtoJNCVI(<130/<85mmHgforptswithdiabetesandrenaldysfunction,<140/<90mmHgforallothers)StudyCharacteristicsConductedin862Sitesin14CountriesRecruitmentfrom9/97-12/00;22,576patientsrandomized(ITT)Follow-upcompletedendof2/03Prelimin

4、aryresults4/2/03;updatedresults9/3/03INVESTTime(Months)DiastolicSystolicCAS(n)11,267NCAS(n)11,309859477387119855886397758784257213659867677267148857386947710785058343679MeanBloodPressurep=0.26p=0.41ChangeinBP(mmHg)SystolicDiastolic24MonthsOverallBPControlat24Months%PatientsBPGoal<140/<90mmHg--INV

5、EST----ALLHAT--63637161575472010203040506070804845--LIFE--CASNCASCASNCASCHLORAMLLISLOSATENJNCVIAlive,FreeofMIorStrokePrimaryOutcomeTotalfollow-up61,835patient-yrsMeanfollow-up2.7yrs/patientAnnualeventrate=3.6%7580859095100Cumulative%Months06121824303642485460logrankp=0.57RR=0.98,95%CI0.90,1.06CIf

6、orequivalence0.83,1.20CASNCAS0.801.21.0CASBetterNCASBetterCASNCASn=11267n=11309OutcomeNo.(%)No.(%)pvalueFirstEvent1119(9.93)1150(10.17)0.57Death873(7.75)893(7.90)0.72NonfatalMI151(1.34)153(1.35)0.95NonfatalStroke131(1.16)148(1.31)0.33CVDeath431(3.83)431(3.81)0.94CVHospitalization726(6.44)709(6.27

7、)0.59PrimaryandSecondaryOutcomesUnadjustedRelativeRiskwith95%CICASNCASn=8101n=8082OutcomeNo.(%)No.(%)New-OnsetDiabetes569(7.03)665(8.23)DeathorNew-OnsetDiabetes1050(12.97)1177(14.57)PrimaryEventorNewOnsetDiabetes1185(1