代文治疗高血压及心医衰中的应用地位.ppt

解读 ACC/AHA 2005 心衰指南代文?在高血压及心衰治疗中地位  ;Heart Failure in the United States;慢性心衰发病率 ;心衰预后;The Cardiovascular Continuum:Targeting Mechanisms and Mediators;Stages of Renal and CV Disease;Natural History of CVD Progression;CAD Hyp CM Valv;心血管事件链;心衰危险因素;ACC/AHA Practice GuidelinesPyramid Approach to HF Stages; 心衰的A阶段 ;Evolution of Cardiovascular Events: ACC/AHA Stage A Heart Failure; Average Percent Reduction Stroke incidence 35-40% Myocardial infarction 20-25% Heart failure 50% ;Not at Goal Blood Pressure (140/90 mm Hg) (130/80 mm Hg for those with diabetes or chronic kidney disease);大量临床试验证明了ARB卓越的治疗作用 ARB不仅在应用ACEI发生咳嗽时推荐使用 无咳嗽时仍可以使用 确立了ARB在高血压伴有某些特殊疾病时的治疗地位 ;ARB在特殊疾病时的治疗地位;代文降压疗效与氨氯地平相同;双倍剂量代文降压疗效优于双倍剂量依那普利;不同 ARB治疗后的血压下降值(mmHg);心肌缺血发生的时间与分钟;Time-Dependent Effects of Valsartan on ABP: Double-Digit 24-h BP Reductions With Morning or Evening Dosing;Treatment With Valsartan Reduces Percent of Nocturnal Non-dippers ; 心衰A期的组织结构的 的主要变化 ARB在心衰A期的干预作用;血管主要的结构病变特性;Vascular Remodeling: Clinical Implications;Coronary reserve in hypertension and LVH;LV 功能不全;Ang II and Vascular Remodeling;Influence of Angiotensin II on the Blood Vessel;6%;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;*; Valsartan Improves Vessel Elasticity*;*P 0.005 vs placebo.Adapted with permission from Peters S et al. J Invasive Cardiol. 2001;13:93-97.;心衰 - 心血管事件链的最后阶段; Sympathetic Nervous System;异常的血管收缩 ;Pathophysiologic Effects of Ang II;Sympathetic Fibers Angiotensinogen NE b Renin receptors (kidney,heart, vessels) Presynaptic Angiotensin I AT1 receptor ACE Angiotensin II ;Levels;BNP (pg/ml);降低进程 I; 传统的心衰常规治疗 -----强心、利尿、扩血管 已被以神经内分泌拮抗剂为主的新的“常规治疗”或“标准治疗”所取代： ACEI/ARB、?受体阻滞剂、利尿剂、有时加用地高辛;2001 ACC/AHA Practice GuidelinesPyramid Approach to HF Therapy;Neurohormonal Activation in