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1、从近期大型临床试验看高血压治疗的策略河北医科大学第二医院心内科李拥军中国人群高血压患病率（％）年年龄样本数高血压△（%）患病率1959>15500,0005.11980>154,000,0007.7↑411991>15900,00012.6↑542002>18270,00018.8↑31中国高血压知晓率、治疗率和控制率（％）知晓率治疗率控制率*199126.317.14.1200230.224.76.1美国2000705934*SBP<140mmHg和DBP<90mmHgIHD＝IschemicHeartDiseaseProspect
2、iveStudiesCollaboration.Lancet.2002;360:1903-1913.收缩压舒张压UsualDiastolicBP(mmHg)50-59years60-69years70-79years80-89yearsAgeatrisk:40-49years25612864321684210809010011070IHDMortality (FloatingAbsoluteRiskand95%CI)UsualSystolicBP(mmHg)50-59years60-69years70-79years80-89year
3、sAgeatrisk:40-49years25612864321684210120140160180血压、年龄与冠心病死亡率(100万人群资料分析)降压治疗临床试验荟萃分析结果T=treatmentC=controlNon-fataleventsFataleventsTCTCTCTCNumbersindividuals020040060080010001200%reductioninoddsStroke39%CHD16%Vasculardeaths21%Allotherdeaths2%BloodPressureLoweringTrea
4、tmentTrialists’CollaborationBPLTC协作研究Secondcycleofoverviewanalyses（2003）InstituteforInternationalHealth广泛的病人群和代表性纳入162341病人平均年龄65岁，52％男性平均随访2－8年共随访超过700000病人年BPLTC协作研究:前瞻性荟萃分析0.51.02.0RelativeRiskRR(95%CI)BPDifference (mmHg)FavorsFirstListedFavorsSecondListedMajorCVeven
5、tsCVmortalityTotalmortality1.02(0.98,1.07)2/0ACEIvsD/BB1.03(0.95,1.11)2/0ACEIvsD/BB1.00(0.95,1.05)2/0ACEIvsD/BB1.04(0.99,1.08)1/0CAvsD/BB1.05(0.97,1.13)1/0CAvsD/BB0.99(0.95,1.04)1/0CAvsD/BB0.97(0.92,1.03)1/1ACEIvsCA1.03(0.94,1.13)1/1ACEIvsCA1.04(0.98,1.10)1/1ACEIvsCABlo
6、odPressureLoweringTreatmentTrialists’Collaboration.Lancet.2003;362:1527-1535.BP-LoweringTreatmentTrialistsComparisonsofDifferentActiveTreatmentsCORONARYHEARTDISEASEComparisonsofdifferentactivetreatmentsRR(95%CI)FavoursfirstlistedFavourssecondlistedBPdifference(mmHg)0.51
7、.02.0RelativeRisk0.96(0.88,1.05)1.01(0.94,1.08)0.98(0.91,1.05)ACEvs.CACAvs.D/BBACEvs.D/BB2/01/01/1STROKEComparisonsofdifferentactivetreatmentsRR(95%CI)FavoursfirstlistedFavourssecondlisted0.51.02.0RelativeRiskBPdifference(mmHg)1.09(1.00,1.18)ACEvs.D/BB0.93(0.86,1.01)CAv
8、s.D/BB1.12(1.01,1.25)ACEvs.CA2/01/01/1以往大量临床研究表明，降压治疗的益处主要来自血压降低本身临床试验证实长期有效降压治疗能减少30%-50%心脑血管病发生率。不同的降压药物只要能够
