高血压临床指南与经验治疗.pptVIP

遵循高血压药物治疗的原则 选用长效、缓释制剂，谷峰比值50%，作用持久，降压平稳，病人依从性好。 单一药物治疗疗效不佳时，不主张盲目增加此药剂量以免增加不良反应， 可采用2种或2种以上的药物联合治疗。 联合治疗可协同疗效，减低副作用。合理的配伍还应考虑各药作用时间的一致性。 遵循个体化原则：根据年龄、肝肾功能、并存疾病、药物的作用、代谢、不良反应和药物间的相互作用合理选药。 * * Blood pressures achieved in VALUE were the lowest level ever seen in an international hypertension outcome trial. The unexpected differences seen between the two groups were most marked in the first 6 months of the trial. This may account for some of the results seen within the trial. The differences may have occurred due to the way the trial was designed with 92% patients being rolled over from previous therapy with no wash out period. A similar result was seen in All-Hat. VALUE was not BP comparison study. At study end (72 months) or final visit, SBP averaged 139.3?17.6 mmHg with valsartan-based regimens and 137.5?15.0 mmHg with amlodipine-based regimens. The reduction in SBP from baseline until study end was 15.2 mmHg and 17.3 mmHg in the valsartan and amlodipine groups, respectively. The difference between groups was substantial at 1 month (4.0 mmHg) but decreased to approximately 2.1 mmHg at 6 months and averaged 2.0 mmHg thereafter. SBP decreased in both treatment groups from 6 months until end of study, by 3.3 mmHg in the valsartan group and 3.0 mmHg in the amlodipine group. Control of SBP (140 mmHg) was achieved in 58% of the valsartan group and 64% of the amlodipine group by the end of the trial.1 1. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with valsartan- or amlodipine-based regimens: VALUE, a randomised trial. Lancet. 2004;363:2022-2031. * There was a trend towards fewer fatal or non-fatal strokes in the amlodipine group, 322 vs 281 in the valsartan and amlodipine groups, respectively (HR=1.15 [95% CI 0.98 - 1.36], P=0.08).1 The Kaplan-Meier curves separated early in favor of amlodipine, and the slopes subsequently became parallel for the remainder of the study.1 Subsequent analysis was carried