CCB与心力衰竭_培训课件.ppt

试验设计 目的:评估在血管紧张素转换酶抑制剂依那普利基础上 加用血管扩张药物－钙离子拮抗剂非洛地平对心脏功能的影响 研究设计:随机、双盲、安慰剂对照 随访:达42个月，平均18个月 入选患者：450例充血性心力衰竭的患者， NYHA心功能II-III级 治疗方案：地高辛、利尿剂、依那普利基础上加用非洛地平，5 mg，每天两次，或安慰剂 结 果 Changes from baseline in supine cuff systolic and diastolic blood pressures in the two treatment groups. P.05; *P.01; **P.001. 血压 Changes from baseline in heart rate in the two treatment groups. *P.05. 心率 运动试验 Changes in treadmill exercise time in the two treatment groups. No difference was observed for the first 15 months, but thereafter a trend for better preservation of exercise tolerance appears in the felodipine group. 左心室EF值 Felodipine Placebo P value 3M 2.1±7.0 (n=204） -0.1±6.0 (n=200) 0.001 12M 0.6±8.6 (n=116) -0.6±8.6 (n=115) 0.3 Radionuclide EF was measured at baseline and at 3 and 12 months after randomization. EF was significantly increased in the felodipine ER group at 3 months (n=204; 2.1±7.0% [mean±SD]) compared with the placebo group (n=200; -0.1±6.0%; P=.001). This difference did not persist at 12 months. PNE、ANP Changes in plasma concentration of PNE (A) and ANP (B). PNE increases similarly and progressively in both treatment arms. ANP is significantly suppressed at 3 months in the felodipine group and at 12 months by log transformation of the data, but thereafter ANP rises similarly to that in the placebo group. P.05 (raw data or log transformation); P.05 only on log transformation. 生活质量评定 Change in quality of life as measured by the Minnesota Living With Heart Failure questionnaire. Change scores have been reversed so that a decline indicates worsening of quality of life. Values are similar for the first year, but thereafter a trend for less rapid decline appears in the felodipine group. 终点事件 During the follow-up period, 60 patients died: 31 (13.8%) in the felodipine arm and 29 (12.8%) in the placebo arm. Mortality was therefore similar in the two treatment groups, but the study was not powered to test for a difference. The risk ratio for fe