阿司匹林在高血压指南

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1、阿司匹林在国内外高血压防治指南中的应用沾化县人民医院心内科刘子忠要点阿司匹林在高血压患者中应用的循证医学证据国际和中国的高血压指南如何评价阿司匹林的作用高血压患者使用阿司匹林应注意的问题阿司匹林在高血压患者中应用的循证医学证据EventRateintheHOTStudyComparedWithaTrialMeta-Analysis02468101214AlldeathsCVmortalityAllstrokeAllMIHOTMeta-analysisEvents/1,000patientyearsASAi

2、sBeneficialinPatientsWithWell-TreatedHypertension024681012MajorCVeventsRRR15%AllMIRRR36%AllstrokeASAPlaceboEvents/1,000patientyearsp=0.002p=0.03Lancet1998HOTStudy:BenefitVersusHarminHigherRiskGroups*Decreaseincardiovascularevents(benefits)orincreaseinblee

3、dings(risk)per1,000patientyears**Numberneededtotreattoavoidacardiovascularevent(NNT)ortohaveamajorbleed(NNH)01230100200High/veryhighriskAbsoluteBenefitAbsoluteRiskNNTNNHEvents/1,000patientyearsPatients(n)0123AbsoluteBenefitAbsoluteRiskNNTNNHAllpatientsEven

4、ts/1,000patientyearsPatients(n)0100200HOTStudy:BenefitVersusHarminHigherRiskGroups(cont’d)*Decreaseincardiovascularevents(benefits)orincreaseinbleedings(risk)per1,000patientyears**Numberneededtotreattoavoidacardiovascularevent(NNT)ortohaveamajorbleed(NNH)

5、Serumcreatinine>115mol/l01234567891011121301002003000123450100200300DBP>107mmHgAbsoluteBenefitAbsoluteRiskNNTNNHAbsoluteBenefitAbsoluteRiskNNTNNH01230100200SBP>180mmHgAbsoluteBenefitAbsoluteRiskNNTNNHEvents/1,000patientyearsPatients(n)Events/1,000patient

6、yearsPatients(n)Events/1,000patientyearsPatients(n)抗血栓治疗试验协作组AntithromboticTrialists’Collaboration针对高危患者行抗血小板治疗随机试验的协作分析：最新结果BMJ324:71–86,2002本研究共回顾分析：287项随机临床试验，包括135,000例抗血小板治疗与对照组比较的患者和77,000例不同抗血小板治疗方案比较的患者。主要的研究终点：“严重血管事件”：非致死性心肌梗死，非致死性中风及血管性死亡。抗血栓治疗试

7、验协作组:血管事件分类APTCTRL风险降低值先前MI13.5%17.0%25%±4急性MI10.4%14.2%30%±4先前中风/TIA17.8%21.4%22%±4急性中风8.2%9.1%11%±3其他高危因素8.0%10.2%26%±3除去急性中风以外11.7%14.8%25%±2的所有情况所有试验总和10.7%13.2%22%±2(P<0.0001)1.00.50.01.52.0血管事件的汇总分析试验事件/患者统计比数比&CI*危险性下降AspirinNoAspirin(o-E)Var(Aspirin

8、:NOAspirin)(SD)0.00.51.01.52.0AspirinNoAspirinbetterbetterEffect2P<0.00001一级预防试验:BritishDoctors258/3429132/1710-1.586.8HOT324/9399372/9391-25.3174.0PPP44/222665/2269-10.227.2TPT210/2545253/2540-22.2115