高血压诊断和治疗剖析.pptVIP

* * * * * * * * * * * * * 指南在降压联合治疗中推荐了几种合理的联合方案，其中CCB是联合治疗的主要组分，它可以和ACEI、ARB、噻嗪类利尿剂和β-阻滞剂4种降压药物联合，而ACEI和ARB只可以分别和噻嗪类利尿剂、CCB联合，噻嗪类利尿剂仅能与ACEI、ARB和CCB联合。 * * * * * If we look at the different types of LVH it has been clearly demonstrated that concentric hypertrophy has a particularly serious prognosis in terms of cardiovascular mortality and morbidity. * The consequences of LVH are particularly severe. Patients with LVH are 4 times more likely to suffer a major cardiovascular event, such as stroke or MI, within 5 years if left untreated. * 2007-IRBE-RAF-MD-0001-I Excel HF Module GLB.IRB.07.10.11 Schmieder等人观察了截止2002年9月报道的利尿剂、β阻滞剂、钙拮抗剂、ACEI或ARB 对于原发性高血压LV重量逆转影响的双盲、随机对照研究的医学数据库和综述文献。患者人数加权后相同类别药物的治疗进行合并。方差分析检验不同药物类别对于LV结构的影响的不同。结果：共有80个研究的146个有效治疗人群(n=3767)和17个安慰剂人群(n=346)。校正治疗时间和舒张压变化后，服用的不同类别的降压药有显著差别（p=0.004）：ARBs的左心室重量指数下降13%(95%可信度区间为8%-18%)，钙拮抗剂下降11%(95%可信度区间为9-13%),ACEI下降10%(95%可信度区间 8-12%)，利尿剂下降8%(95%可信度区间5-10%) β阻滞剂下降6%(95%可信度区间3-8%)。 * * * * * * * Angiotensin-converting enzyme (ACE) inhibitors have been shown to reverse proteinuria and prevent progression to renal failure, independently of their effects on blood pressure. This was demonstrated in the Ramipril Efficacy in Nephropathy (REIN) trial, a double-blind, placebo-controlled trial, in which 352 patients with nondiabetic nephropathy were stratified according to degree of baseline proteinuria (stratum 1 = ?3 g/24 hours; stratum 2 = 1 to 3 g/24 hours), and randomized to receive either ramipril or placebo plus conventional antihypertensive therapy. This figure shows the effects of ramipril on 24-hour urinary protein excretion, and on progression toward end-stage renal failure (ESRF) in patients with urinary protein excretion 3 g/day. The REIN follow-up study showed that ACE inhibitor therapy slowed the rate of renal decline and further limited the progression to ESRF. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Randomised placebo-controlled trial of effect of ramipril on declin