ras阻断剂治疗高血压优势及存在的问题傅国胜PPT.ppt

MERIT-HF, AHA nov 98 This figure summarizes our hypothesis. A, Increased formation of angiotensin II by large insulin-resistant adipocytes inhibits recruitment of preadipocytes, resulting in increased storage of lipids in muscle and other tissues, thereby decreasing insulin sensitivity. B, Blockade of the renin-angiotensin system promotes recruitment of preadipocytes, thereby increasing the number of small insulin-sensitive adipocytes. Redistribution of lipids from muscle and other tissues to adipose tissue results in improved insulin sensitivity. Slide 38 LIFE:氯沙坦相比阿替洛尔有效降低颈动脉肥厚 一项LIFE亚组研究比较了氯沙坦和阿替洛尔对颈动脉内膜中层厚度（IMT）的影响31 第3年时，氯沙坦逆转颈动脉肥厚明显优于阿替洛尔（氯沙坦组IMT自基线的变化为–7.9 %，阿替洛尔组为–1.7%; p0.05)31 这一点具有重要意义，因为IMT已经被用作动脉粥样硬化的替代指标45 这些数据提示，氯沙坦治疗可能通过逆转高血压患者的血管重建和降低动脉粥样硬化的形成来降低脑卒中的发生。 氯沙坦更有效逆转IMT的效果独立于降压作用，因为氯沙坦和阿替洛尔组的降压相似 (数据未显示).31 SOURCE: 4-05 CZR 2004-W-7040-SS (slide 21) Ref 31, Source C, p 34, Table 5 Ref 31, Source C, p 34, Table 5 Ref 45, p 188, C1, ?1, L4,7,16,19 Ref 31, Source C, p 34, Table 5 Ref 31, Source C, p 34, Table 5 The principal finding of VALUE was that, for the primary composite endpoint of cardiac mortality and morbidity, there were no significant differences in these high-risk patients treated with valsartan- or amlodipine-based regimens.1 This was observed despite significant differences in achieved blood pressures. In a recent meta-regression analysis based on 30 hypertension trials with 149,407 patients, differences in achieved SBP were found to largely account for cardiovascular outcomes.2 1. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with valsartan- or amlodipine-based regimens: VALUE, a randomised trial. Lancet. 2004;363. 2. Staessen JA, Wang JG, Thijs L. Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003. J Hypertens. 2003;21:1055-1076. 在临床上出现治疗方案的改变有多种原有，研究发现，接近一半的患者是由于血压控制不好和在高血压治疗中改变方案是因为血压控制不好，其次是不良事件，患者不满