ACEI和ARB在高血压治疗中的地位及选择_培训课件.pptVIP

* The initial findings from TALENT provide evidence that in hypertensive patients at high CV risk, the combination of nifedipine GITS and telmisartan lowers BP, which is consistent over the 24h period. Initiating treatment with the combination allowed BP control to be achieved by week 8; office BP data shows that BP reduction was achieved as early as two weeks and was maintained throughout the study. Mortality from any cause and cause-specific mortality were similar among all three treatment groups. The hazard ratio for death in the valsartan group as compared with the captopril group was 1.00 (97.5 percent confidence interval, 0.9-1.11, p=0.98), and the hazard ratio for death in the valsartan and captopril combination group as compared with the captopril group was 0.98 (97.5 percent confidence interval, 0.89-1.09, p=0.73). These results demonstrate that valsartan is as effective as an ACE inhibitor (pre-specified non-inferiority hypothesis was met) in reducing the risk of mortality in this patient population. It was estimated that valsartan had an effect that was 99.6% that of captopril, supporting the conclusion that valsartan is at least as effective as captopril in reducing the risk of major cardiovascular events. VALIANT是活性药物对照研究。我们非常感兴趣的一个问题是：到底与安慰剂比较，缬沙坦能多大程度地提高心梗后患者的生存率？ 此时，由于VALIANT预设了非劣效性检验，且研究患者人群与SAVE、TRACE、AIRE一样。因此，研究者采用了归因分析的统计方法，估计出缬沙坦相对于安慰剂的疗效。结果显示缬沙坦可以保留卡托普利 99.6%的生存利益（95%可信区间：60% －139%），即降低心梗高危患者死亡率达25%。 Flather MD 等人对SAVE, AIRE 和TRACE研究结果所做的荟萃分析结果显示：ACEI可降低心梗高危患者死亡率达26％，因此VALIANT研究证实了缬沙坦同样可降低心梗高危患者死亡率达25％。 【参考文献】 Pfeffer, et al., NEJM 2003;349:1893-1906 * * * Slide 33 LIFE: 新发房颤(AF)/房扑 一项LIFE亚组研究验证了氯沙坦降低LVH患者的新发房颤和相关的心血管事件是否比阿替洛尔更有效。9193例入组LIFE研究的患者中，基线时8851例经ECG检查无AF或AF病史。对这些患者随访66个月，氯沙坦组有150例发生新发AF，阿替洛尔组为221(6.8 vs.10.1 per 1000患者-年)。相对危险降低33% (相对危险0.67 [95% CI: 0.55–0.83], p0.001).33 NEW Ref 33, p 18, Fig 2; p 17, Fig 1 (N’s) Ref 33, p 5, ?2, L1-4; p 8, ?1, L1-2, ?4, L1-3 * LIFE研究是一项由研究人员启动的前瞻性、双盲、活性对照、基于人群的研究，共包括91