从Pure谈β受体阻滞剂的使用选编.ppt

. β-B 714 pts/ 58.3% Treated CHD 1,262 pts*/ 100% Non-Contraindication 546 pts/ 41.5% With Contraindication 2 pts/ 0.2% No β-B 548 pts/ 41.7% When discussing what is essential medicines for CHD, antiplatelet agent is mentioned in the most frequency, next are β-B (same with statins), then followed by ACEI / ARB, CCB and nitrates. Physicians opinions on the reason of why β-B necessary for CHD are: It is recommended as level I medicine in the guideline. It is suggested all patients without contraindications (most physician) It is effective against angina and relieve symptoms well (2 SHCV) It is effective to treat heart failure and to prevent sudden death (SHCV) β-B As A Necessary Medicine For CHD Reasons For Non-use Of β-B Usage of β-B In CHD Therapy Some physicians don’t follow CHD Guide for using β-B in clinical practice. Some physicians don’t know the target heart rate well, and they don’t interfere in HR as long as the patients have no symptoms of angina pectoris. Some physicians are worried about too low of HR and too low of BP. The physicians say they will not prescribe β-B if they think the patients would be sensitive for β-B, their HR or BP would drop too low to: HR: 45-55beats/min BP: 90-100/60mmHg Source: 2010 Betaloc Marketing Strategic Study by Loudon (Base=1,262 patient diaries) * Weighted Data β受体阻滞剂使用率低的一个重要原因 医生对指南处方药物依从性有待提高 调查显示：冠心病以及高血压合并冠心病的治疗方案中β阻滞剂的处方率仅为49.5% 1. Zheng ZJ, Croft JB, Giles WH, Circulation 2001;104:2158-63. 2.我国每年5O余万人死于心脏性猝死。综述与进展. 2007; 36(1): 98. . 冠心病是心脏性猝死的最主要原因 在美国，冠心病占心脏性猝死的潜在病因的比例高达62％ 我国每年有近50余万人死于心脏性猝死，而在心脏性猝死患者中， 80%的原因是冠心病 1. Zheng ZJ, Croft JB, Giles WH, Circulation 2001;104:2158-63. 2.我国每年5O余万人死于心脏性猝死。综述与进展. 2007; 36(1): 98. . 亲脂性的?受体阻滞剂具有长期心脏保护作用（二级预防试验） 试验名称 药物 亲脂性 心脏保护 BHAT 普萘洛尔 高 有 Hjalmarson et al 美托洛尔 中 有 Julian et al 索他洛尔 低 无 Norwegian Study Group 噻吗洛尔 中 有 Olsson et al(五项试验汇总) 美托洛尔 中 有 Kendall MJ. Am J Cardiol 1997, 80(9B):15J-19J 心梗5项研究汇总分析：美托洛尔显著降低心梗患者的猝死风险 Olsson G et