降压治疗研究新动向.pptVIP

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降压治疗研究新动向.ppt

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降压治疗研究新动向

降压治疗研究新动向强化、优化和简化 RAS阻滞剂治疗心血管高危患者循证证据 Antihypertensive drug treatment and the development of diabetes：Meta-analysis Day 2, slide 180 (Elliott) Nifedipine CR/candesartan reduced urinary albumin excretion more than high-dose candesartan monotherapy. A significant reduction in urinary albumin excretion (UAE) was noted in the combination therapy group (P 0.01), but no significant changes were observed in the up-titrated monotherapy group. However, there was no significant difference in post-treatment values between the two groups. In a subgroup analysis in patients positive for microalbuminuria, similar proportions of those initially negative for microalbuminura became positive after the double-blind treatment period: five of 49 patients (6.2%) in the combination therapy group and six of 52 (7.9%) in the up-titrated monotherapy group. After treatment, the microalbuminuria normalized in 17 (34.7%) and 9 (17.3%) patients, respectively; the rate of normalization thus tended to be greater in the combination therapy group than in up-titrated monotherapy group (P = 0.068). In addition, a significant reduction in UAE was observed in the combination therapy group (median from 61.9 to 40.5 mg/g creatinine, P 0.05), but not in the up-titrated monotherapy group (median from 67.6 to 62.3 mg/g creatinine), and the post-treatment values were significantly lower with the combination therapy than with the up-titrated monotherapy (P0.05) Hasebe N, et al. Controlled-release nifedipine and candesartan low-dose combination therapy in patients with essential hypertension: the NICE Combi (Nifedipine and Candesartan Combination) Study. J Hypertens 2005;445-53 研究结果显示,测量冠脉所有节段的最小腔径(MLD)变化,硝苯地平组治疗前后最小腔径几乎无变化[(0.02±0.27) mm,P=0.543],而ACEI组治疗后腔径明显缩小[(-0.12±0.27)mm,P0.001],两组间差异显著(P=0.002)。硝苯地平组出现冠脉病变进展的支数明显少于ACEI组(P=0.019),两组间发生病变进展(病变≥1处)的患者人数也有显著差异(P=0.040)。 ADVANCE Investigator mtg ESC * 累计事件发生率（%） HR (95% CI): 0.80 (0.72, 0.90) (天) P = 0.0002 ACEI / HCTZ C