降压治疗研究新动向

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1、降压治疗研究新动向强化、优化和简化扩展降压治疗能获益的人群，当前主要聚焦在80岁以上高龄高血压患者和血压水平<140/90的心血管高危患者(心、脑血管病与糖尿病)。新动向(一)Theresultsofthistrialshouldprovidereliableevidenceabouttheeffectsofblood-pressure-loweringtherapyinthisveryhigh-riskpopulation.安慰剂纳催离缓释片±雅施达安慰剂HYVET:总死亡率总死亡率降低21%随访时间（年）百分率

2、%纳催离缓释片±雅施达1912193314921565814877379420202231从HYVET到临床实践■适用于收缩压160mmHg以上，一般状况尚好，生活能自理，认知功能无明显减退的高龄高血压患者。■降压速度应该相对较平缓，避免体位性低血压。血压控制目标值150/80mmHg。RAS阻滞剂治疗心血管高危患者循证证据HOPE(Ramipril,2000)PROGRESS(Perindopril,2001)EUROPA(Perindopril,2003)ADVANCE(Perin/Indap,2007)ONT

3、ARGET(Telmisartan,2008)HOPE139/793/3PROGRESS147/869/4EUROPA137/825/2ADVANCE145/815/3ONTARGET142/826/4基线血压血压↓RAS阻滞剂治疗心血管高危患者基线血压与血压下降幅度mmHgHTNTSD159.0159.094.091.0136.0127.279.074.8BloodPressurevaluesinPROGRESS在心血管高危患者,强化血压控制。血压控制目标值<130/80mmHg正在不断获得循证证据。新动向(二)

4、SBPFromUKPDStoADVANCEUKPDSADVACCORDStudyActiontoControlCardiovascularriskinDiabetesPrisantLM.JClinPharmacol2004;44(4):423-430●HbA1c:≤6.0%vs7.0-7.9%(因强化治疗总死亡率增加,08年2月7日宣布提前中止)●SBP:≤120mmHgvs≤140mmHg100120140160180Systolicbloodpressure(mmHg)1248Annualrate(%)Isch

5、aemicstroke100120140160180Systolicbloodpressure(mmHg)0.010.020.040.080.160.32HaemorrhagicstrokeArimaH,etal.JHypertens.2006;24:1201-1208PROGRESS:AdjustedrelativeofdoublingofserumcreatinineorESRD(±95%CI)UsualsystolicBP(mmHg)duringfollow-upProteinuria≥1g/dayProte

6、inuria<1g/day10612<110110-119120-129130-139140-159>1604.805.408.401.701.20.702.224.811.60Reference1.2100806040200<120120-139140-15960100806040200<7070-7980-8990Achievedsystolicbloodpressurelevels(mmHg)Achievedsystolicbloodpressurelevels(mmHg)Age-andsex-adjus

7、tedincidencerateCKD:Ptrend=0.004Non-CKD:Ptrend<0.0001CKD:Ptrend=0.001Non-CKD:Ptrend<0.0001CKDNon-CKDIncidencerate(1000person-years)PROGRESSCKDSubstudy:SBPandCVD020406080100110100120130140150160170180190200210220Nadir,129.5mmHgSystolicBloodpressure,mmhgRelative

8、Hazard,×3700204060801005060708090100110120Nadir,73.8mmHgDiastolicBloodpressure,mmhgRelativeHazard,×2200MesserliFH,etal.AnnInternMed.2006;144:884-893冠心病患者血压控制水平与心血管危险RosendorffC,eta