培训课件-ARB在肾脏病中的应用.pptVIP

暂停ACEI/ARB可能会使蛋白尿增加，但是对于接近CKD5期的患者，该研究发现停药后尿蛋白无明显变化。这可能是由于对于终末期肾脏病患者，多为肾小球硬化改变，而存在高滤过的肾小球已经较少，因此ACEI/ARB类药物对其没有影响。 停药后血压升高可以通过增加其他药物来进行控制,因此对血压的影响也并不明显。 Slide 38 LIFE:氯沙坦相比阿替洛尔有效降低颈动脉肥厚 一项LIFE亚组研究比较了氯沙坦和阿替洛尔对颈动脉内膜中层厚度（IMT）的影响31 第3年时，氯沙坦逆转颈动脉肥厚明显优于阿替洛尔（氯沙坦组IMT自基线的变化为–7.9 %，阿替洛尔组为–1.7%; p0.05)31 这一点具有重要意义，因为IMT已经被用作动脉粥样硬化的替代指标45 这些数据提示，氯沙坦治疗可能通过逆转高血压患者的血管重建和降低动脉粥样硬化的形成来降低脑卒中的发生。 氯沙坦更有效逆转IMT的效果独立于降压作用，因为氯沙坦和阿替洛尔组的降压相似 (数据未显示).31 SOURCE: 4-05 CZR 2004-W-7040-SS (slide 21) Ref 31, Source C, p 34, Table 5 Ref 31, Source C, p 34, Table 5 Ref 45, p 188, C1, ?1, L4,7,16,19 Ref 31, Source C, p 34, Table 5 Ref 31, Source C, p 34, Table 5 Slide 17: LIIFE: Stroke Losartan reduced the risk of fatal and non-fatal stroke, a major cause of death and disability, by 25% compared with atenolol. This risk reduction was highly significant (p=0.0010).1 This cerebrovascular protective benefit in patients treated with losartan was greater than has been observed in trials of varying hypertensive patient populations in comparisons of CCB-based therapy with diuretic-based or beta blocker-based therapy.35 The superior risk reduction in stroke with losartan vs. atenolol in the LIIFE study suggests an important role for losartan in patients with hypertension beyond the effects of blood pressure reduction alone.1 Angiotensin II (Ang II) increases atherosclerotic cardiovascular disease. Renal damage that is characterized by activation of Ang II markedly potentiates the risk for atherosclerosis, even in the setting of subtle renal impairment. Therefore, whether antagonism of Ang II actions can modify atherosclerosis in a model of mild renal impairment was examined. Apolipoprotein E–deficient spontaneously hyperlipidemic mice underwent uninephrectomy (UNx) or sham operation (sham) followed by treatment with Ang II receptor antagonist losartan or hydralazine for 12 wk. While UNx did not increase the serum creatinine levels, BP and lipids were higher in U