ARB替米沙坦.ppt

美卡素?治疗高血压强效、长效、富有特点的ARB 血管紧张素Ⅱ受体拮抗剂(AⅡA,ARB,AT1RA) Biphenyl tetrazoles - 氯沙坦 Losartan - 厄贝沙坦 Irbesartan - 替米沙坦 Telmisartan - 坎地沙坦 Candesartan - 奥美沙坦 Olmesartan Non-biphenyl tetrazoles - 依普沙坦 Eprosartan Non-heterocyclic - 缬沙坦 Valsartan 美卡素?(替米沙坦)独特的化学结构 结构上结合异芳香替代物后，美卡素?分子结构呈正、负电荷均衡， 正、负电荷均衡的独特结构，与AT1拮抗剂的理论构象极其相似,  更好识别AT1受体 不同ARB与AT1受体的结合力 Renal excretion Telmisartan + HCTZ  美卡素?血压控制达标率(%) 血压晨峰(Morning Blood Pressure Surge, MBPS) 血压晨峰(MBPS)与心血管危险507例7年随访的Cox多因素分析 Blood pressure control in the risky early-morning hours ARBs降压T/P比值 T/P Ref. Losartan 50mg SBP 0.52 Current Therapeutic DBP 0.57 Research 1999;60:195 Valsartan 80mg SBP 0.65 Current Therapeutic DBP 0.62 Research 1999;60:195 Eprosartan 600mg DBP 0.67 J Hypertens 1999;17:129 Irbesartan 150mg DBP 0.65 Am J Hypertens 1998;11:462 Candesartan 16mg SBP 0.90 Am J Hypertens 1997;10(part2):85 DBP 0.90 Telmisartan 80mg SBP 0.92 Am J Cardiol 1999;84:7k DBP ?1.00 ARBs降压平滑指数(SI) Evidence for Telmisartan on MBPS in at-risk Patients MICADO Ⅰ Ⅱ Telmisartan vs Valsartan PRISMA Ⅰ Ⅱ Telmisartan vs Ramiprol SMOOTH Telmisartan+HCTZ vs Valsartan+HCTZ ATHOS Telmisartan+HCTZ vs Amolodipine+HCTZ MICADO I II multi-center double blind/dummy dose titrated randomized controlled trial MICADO I II multi-center double blind/dummy dose titrated randomized controlled trial  Early morning protection with Micardis vs ramipril Mechanisms and Hormonal Systems Involved in Obesity-Associated Hypertension Micards: Summary of efficacy in the early morning Main inclusion criteria ? T2DM, ?Hypertension (seated SBP/DBP 130 and or 80 mmHg, or anti-hypertensive treatment), ?Diabetic nephropathy defined as: -proteinuria ≥700 mg/g creatinine -and a serum creatinine 3.0 mg/dL Study design Primary endpoint ABPM ABPM ABPM 2–4 weeks 6 weeks 2 weeks 6 weeks (n=375) R 2.5 mg R 5 mg R 10 mg (n