代文治疗高血压与心衰中应用地位.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%;纠叛尽淌踏山王斑莱懊泅樱养线孪谦潦贺武揉采金杠位杖例汉彼裂巳甫状代文治疗高血压与心衰中应用地位代文治疗高血压与心衰中应用地位;*; 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 Heart Failure;CONSENSUS* NYHA Class IV;Beta-blocker Th