基于临床试验高血压治疗策略PPT.ppt

VALUE: Main Results Good BP control was achieved with both treatment regimens, but BP decrease in the amlodipine group was more pronounced, particularly early in the trial Despite BP differences, the primary composite cardiac endpoint in both groups was not different Julius S et al. Lancet. June 2004;363. VALUE: Other Results Incidence of stroke was lower, but not significantly, in the amlodipine group Incidence of non-fatal MI was significantly lower in the amlodipine group There was a positive trend in favour of valsartan for less heart failure but this did not reach significance There was a highly significant lower rate of new-onset diabetes in the valsartan group Julius S et al. Lancet. June 2004;363. Hypertension Treatment Strategy Based on Clinical Trials Liu Lisheng Is antihypertensive treatment beneficial? Trials of active treatment vs. placebo (or more vs. less) When should drug treatment start? (BP level? Mild hypertension? Risk stratifications?) Whom should be treated? (Severe, mild, ISH) To what extent? Is BP lowering by different antihypertensive agents equally beneficial? Necessity of Conducting Large-scale Clinical Studies using Asian Subjects Trials Year Contributions VA Trial The VA Cooperative Study on Antihypertension Drugs 1967 Severe HT should be treated HDFP The HT Detection and Follow-up Program(Australia) 1976 Large-scale CT could be conducted well successfully in community ANBPS Australian National BP Study 1979 A 4-month observation period is advisable before instituting drug treatment MRC trial The MRC Trial of Treatment in Mild HT(British) 1977 Absolute benefits were small in mild HT, treat 850 pts save 1 stroke Mild HT, a weak claim for status as an entity Trials Year Contributions BHAT ?- blocker Heart Attack Trial 1981 CHD could be reduced in POST-MI pts. by ?-blocker EWPHE The European working Party on High BP in the Elderly 1984 Elderly HT pts. would ben