高血压的治疗：新的循环医学证据

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1、高血压治疗新的循证医学证据华中科技大学协和医院心内科廖玉华高血压治疗：新的循证医学证据ADVANCE研究—固定复方制剂VALIDD研究—降压与心室舒张功能Ameta-analysisofRCTs中国人高血压临床试验证据ADVANCE研究:在11,140例2型糖尿病患者中进行的降压与强化血糖控制的析因随机临床试验培哚普利吲达帕胺固定复方制剂（百普乐）对重要血管事件的影响InclusioncriteriaType2diabetesmellitusAge55yearsorolderAdditionalriskofva

2、sculareventAge65yearsHistoryofmajormacrovasculardiseaseHistoryofmajormicrovasculardiseaseFirstdiagnosisofdiabetes>10yearspriortoentryOthermajorriskfactorHypertensiveornormotensiveRandomisedstudytreatmentsBloodpressureloweringDouble-blindperindopril-indapamid

3、eversusmatchingplacebo2.0/0.625mgorplaceboforfirst3months4.0/1.25mgorplacebothereafterBloodglucoselowering(ongoing)Open-labelgliclazideMR-basedintensivetherapytargetinganHbA1cof6.5%versususualguideline-basedcareAmongpatientswithdiabetes,doesbloodpressurelower

4、ingtherapy:Produceadditionalbenefitswhensystolicpressureisloweredbelow145mmHg?Producesimilarbenefitsforhypertensiveandnon-hypertensivepatients?AddtothebenefitsproducedbyothercardiovascularpreventivetherapiesincludingACEinhibitors?ADVANCEstudyhypothesesPerindo

5、pril-indapamidearmADVANCETrialprofile12877withtype2diabetesregistered11140randomised5569assignedperindopril-indapamidecombination1737withdrewduringrun-inScheduledendoffollow-up:4.3years4908(88%)assessedatfinalvisit4081(73%)adherenttotreatment4losttofollow-up1

6、1losttofollow-upScheduledendoffollow-up:4.3years4863(87%)assessedatfinalvisit4143(74%)adherenttotreatment5571assignedmatchingplacebo血压降低情况Δ2.2mmHg(95%CI2.0-2.4);p<0.001Δ5.6mmHg(95%CI5.2-6.0);p<0.001DiastolicSystolic安慰剂组培哚普利/吲达帕胺组MeanBloodPressure(mmHg)6575859

7、5105115125135145155165Follow-up(Months)R6121824303642485460140.3mmHg134.7mmHgAverageBPduringfollow-up77.0mmHg74.8mmHg全因死亡率Follow-up(months)01006121824303642485460安慰剂组培哚普利/吲达帕胺组Cumulativeincidence(%)Relativeriskreduction14%:95%CI2-25%p=0.0255死亡分析心血管死亡Follow-up

8、(months)6121824303642485460安慰剂组培哚普利/吲达帕胺组非心血管死亡Follow-up(months)6121824303642485460安慰剂组培哚普利/吲达帕胺组相对危险降低18%;p=0.027相对危险降低8%;p=0.415%5%Cumulativeincidence(%)Coronaryevents*2P=0.02†Non-fatal