从最新研究证据重新思考β-受体阻滞剂在降压治疗中的地位PPT.ppt

* 从最新研究证据重新思考b-受体阻滞剂在降压治疗中的地位 河北省人民医院 郭艺芳 Lindholm荟萃分析主要结果 Lancet 2005;366:1545 β-受体阻滞剂在预防心脏性猝死方面并不优于其他任何降压药物，但在预防卒中方面却显著劣于其他药物 Lindholm荟萃分析主要结论 Only minimal evidence suggests β-blockers reduce the morbidity and mortality associated with hypertension, especially among the elderly. Clinicians must be sceptical of using drugs for which only surrogate marker evidence is available. All patients 60 and older who are taking β-blockers for hypertension alone should be reassessed because β-blockers are not in a class of agents that reduces morbidity and mortality. Even among patients younger than 60, β-blockers should not be first-line agents. Lancet 2005;366:1545 The NICE Hypertension Guideline Update 2006 Messerli：荟萃分析 JACC,2008;52:1062 β-受体阻滞剂并不能更为有效的预防心脏事件的发生，但在老年患者中卒中发生率却增加19% 。因此此类药物不应作为高血压患者（特别是老年患者）的首选降压药物 Bangalore：研究结果 JACC,2008;52:1482 Bangalore：研究结果 JACC,2008;52:1482 高血压患者应用β-受体阻滞剂降低心率可能增加心血管事件和死亡风险，且心率越慢，风险越大。 Kaplan述评 Beta-blockers in hypertension ——adding insult to injury! JACC,2008;52:1490 β-阻滞剂在降压治疗中的证据 BPLT第二次荟萃分析 ： 将β-受体阻滞剂与利尿剂的资料混同处理 STOP-Hypertension 2 ： 将β-受体阻滞剂与利尿剂的资料混同处理 CAPPP研究 ： 将β-受体阻滞剂与利尿剂的资料混同处理 MAPHY研究 ： 受试者为年龄40-64岁的白人男性 0.5 1.0 2.0 Relative Risk RR (95% CI) BP Difference(mm Hg) FavorsFirst Listed FavorsSecond Listed Major CV events CV mortality Total mortality 1.02 (0.98, 1.07) 2/0 ACEI vs D/BB 1.03 (0.95, 1.11) 2/0 ACEI vs D/BB 1.00 (0.95, 1.05) 2/0 ACEI vs D/BB 1.04 (0.99, 1.08) 1/0 CA vs D/BB 1.05 (0.97, 1.13) 1/0 CA vs D/BB 0.99 (0.95, 1.04) 1/0 CA vs D/BB 0.97 (0.92, 1.03) 1/1 ACEI vs CA 1.03 (0.94, 1.13) 1/1 ACEI vs CA 1.04 (0.98, 1.10) 1/1 ACEI vs CA Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet. 2003;362:1527-1535. BP-Lowering Treatment TrialistsComparisons of Different Active Treatments STOP-Hypertension 2 Patients were randomly assigned conventional antihypertensive drugs (atenolol 50 mg, metoprolol 100 mg, pindolol 5 mg, or hydrochlorothiazide 25