高血压欧洲新指南和小剂量联合用药PPT课件.ppt

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1、NewEuropeanGuidelinesandTheRoleofLow-doseCombinationsBernardWaeberLausanne,SwitzerlandESH-ESCGuidelines,JHypertens2003-BP<140/90mmHginallhypertensivepatients<130/80mmHginhypertensivepatientswithdiabetesorrenaldisease-ControlofallcardiovascularriskfactorsGoalsoftreatmentSympatheticnervoussy

2、stemRenin-angiotensinsystemTotalbodysodiumPatient1Patient2Patient3DosetitrationPercentmaximumeffectDosearbitraryunits0110100100010000020406080100TherapeuticeffectToxiceffectCriticaldoseOptimaldoseLawetal,BMJ2003PercentageofpatientswithAEStandarddoseTwicestandarddoseHalfstandarddose-blocker

3、sACEinhibitorsThiazidesCalciumantagonistsAT1-receptorblockers20151050-5N°oftrials:5996629644SequentialmonotherapyPercentageofpatientswithnormalbloodpressureDrugA020406080100%DrugsCDrugBAchievedBP:<140/90mmHgDickersonetal,Lancet,1999Duringmonotherapy(diuretic,b-blocker,ACEinhibitororCaantago

4、nist)%39020406080BPcontrolrateduringantihypertensivemonotherapySequentialmonotherapyanddoserangingstrategy:yes,but…!-bloodpressurenormalizationinonlyafractionofhypertensivepatients-eachdrugclasscannotbegiventoeachpatient-dose-dependentside-effectsformostantihypertensiveagents-timeconsuminga

5、pproachpossiblediscouragementofthepatientand…ofthedoctor!CombinationtherapyPercentageofpatientswithnormalbloodpressureDrugA020406080100%DrugsA+BDrugBCombinationtherapy:rationale-Combinationofdrugsloweringbloodpressurebydifferentmechanismsantihypertensiveefficacy-Complementaryactionsofdrug

6、sfromdifferentclassespreventionofcounter-balancingmechanismsantihypertensiveefficacy-Lowerdosesgenerallyneededwhentwodrugsarecombinedincidenceofside-effectsSystolicDiastolic0-5-10-5EffectsoftwodifferentdrugsonBPseparatelyandincombination(119randomizedplacebocontrolledtrials)Placebo-sub

7、tractedBPresponse.mmHgLawetal,BMJ2003"First"drugalone"Second"drugaloneCombinationOn1drug100806040200PercentPercentofALLHATparticipantswhoachievedtheirgoalbloodpressure(SBP/DBP<140/90mmHg)Cushmanetal,JClinHypertens,2002061224364860On2drugsOn3drugsOn>4drug