心脑血管病的慢病管理.ppt

* BP Reductions as Little as 2 mm Hg Reduce of the Risk of CV Events up to 10% Data from a meta-analysis of 61 prospective, observational studies has also provided powerful evidence that throughout middle and old age, BP is strongly and directly related to vascular mortality.7 These findings show, for example, that a 10 mm Hg lower systolic BP is associated over the long term with a 40% lower risk of stroke death and a 30% lower risk of death from ischemic heart disease (IHD) or other vascular causes. Importantly, within each decade of life between 40 and 89 years the proportional difference in the risk of vascular death associated with a given absolute difference in mean BP is roughly equivalent down to at least 115 mm Hg for systolic BP and 75 mm Hg for diastolic BP (below which there is little evidence). Thus, there was no evidence of a J curve across all middle and older age groups. Perhaps most striking are the practical implications of these data: even a small, 2 mm Hg fall in mean systolic BP would be associated with large absolute reductions in premature deaths and disabling strokes.7 As shown here, a 2 mm Hg lower mean systolic BP could lead to a 7% lower risk of IHD death and a 10% lower risk of stroke death. 7 Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-1913. Slide 17: LIIFE: Stroke Losartan reduced the risk of fatal and non-fatal stroke, a major cause of death and disability, by 25% compared with atenolol. This risk reduction was highly significant (p=0.0010).1 This cerebrovascular protective benefit in patients treated with losartan was greater than has been observed in trials of varying hypertensive patient populations in comparisons of CCB-based therapy with diuretic-based or beta blocker-based therapy.35 The superior risk reduction