高血压防治进.ppt

* * * * * * 基线时各组血压无明显差异. 随访6年,平均收缩压,络活喜组比氯噻酮组高0.8mmHg(P=0.03), 赖诺谱利组比氯噻酮组高2mmHg(P0.001), 尤其在老年人组高3mmHg，在黑人组高4mmHg.说明赖诺普利组在降低收缩压方面不如络活喜和氯噻酮,尤其对老年人和黑人. 平均舒张压,络活喜组比氯噻酮组低0.8mmHg(P=0.001), 而赖诺谱利和氯噻酮没有明显差异. 络活喜组降低舒张压在三组最好. ALLHAT 研究显示了络活喜出色的血压控制 * 络活喜在降低主要及所有次要终点作用与利尿剂相当,(脑卒中有进一步下降趋势), 同时,与利尿剂不同, 络活喜对血糖,血脂,血钾代谢均可无不良影响. 需要强调的是, 在中国, 利尿剂低钾的发生率更高,与中国人高钠低钾饮食有关. 基线时非糖尿病患者在第4年发生糖尿病的比率在氯噻酮、络活喜和赖诺普利组分别为11.6%，9.8%和8.1%. 治疗第4年络活喜组胆固醇水平显著低于氯噻酮组 因此络活喜可用于合并糖尿病和高血脂的高血压患者,无需考虑对代谢的副作用. * * The broad scope of the VALUE trial is illustrated; 31 countries participated in the trial. Randomisation began in 1997 and was completed in December of 1999. Characteristics of the entire patient population were published in 2001.1 A total of 15,314 patients in 31 countries met the blood pressure and other inclusion criteria and were randomised, making VALUE one of the largest interventional studies in essential hypertension. The largest numbers of patients were randomised in the USA (n = 3676) followed by Germany (n = 1557), Italy (n = 1095), UK (n = 887) and France (n = 841). In total, 947 centers randomised patients; the vast majority of these were primary care centers providing fewer than 40 patients. 1 1. Kjeldsen SE, Julius S, Brunner H, et al. Characteristics of 15,314 hypertensive patients at high coronary risk. The VALUE trial. The Valsartan Antihypertensive Long-term Use Evaluation. Blood Press. 2001;10:83-91. * During enrolment, more men than women were randomised during every month of the inclusion period, resulting in a total of 57.6% men (n = 8816) in the trial.1 The valsartan and amlodipine arms were well balanced for gender, age, body mass index (BMI), severity of hypertension, antihypertensive therapy prior to enrolment, heart rate, and race.2 1. Kjeldsen SE, Julius S, Brunner H, et al. Characteristics of 15,314 hypertensive patients at high coronary risk. The VALUE trial. The Valsartan Antihypertensive Long-term Use Evaluation. Blood Press. 2001;10:83-91 2. Julius S, Kje