难治性高血压处理-课件，幻灯，ppt_精品.ppt

相对醛固酮过多引起治疗抵抗的作用，甚至超过经典的原发性醛固酮增多症 建议对所有顽固性高血压患者均测定醛固酮－肾素比例(ARRs) ，以利于治疗的决策。 Semplicini A,et al. Am J Hypertens 2006;19:373-379 Efficacy of Eplerenone Added to Renin-Angiotensin Blockade in Hypertensive Patients  placebo (虚线) or eplerenone (实线) added to patients receiving background ACE inhibitor or ARB over the 8-week study period Krum H et al. Hypertension 2002，40:117-123 校正安慰剂效应后， 加用依普利酮可进 一步降低SBP 5.9 mmHg 和DBP2.4 mmHg 新指南关于醛固酮拮抗剂的应用 … … are likely using them(指醛固酮拮抗剂）to a greater degree, but they are probably not being broadly used… … (指醛固酮拮抗剂） requires special biochemical monitoring, particularly to measure blood levels of potassium due to the risk of hyperkalemia New Guidelines Tackle Treatment of Resistant Hypertension AHA 2008, 7 Aptil Thank you * Sort out * VALUE was designed as a randomised, double-blind, active-controlled, parallel, 2-arm comparison with a response-dependent dosage titration scheme.1 Patients aged 50 years and over, with a high-risk cardiovascular profile and essential systolic and/or diastolic hypertension, were randomised to stepwise titrations of valsartan or amlodipine, with HCTZ and later free add-on of other antihypertensive agents excepting ACE inhibitors, calcium channel blockers, ARBs, or diuretics other than HCTZ (except that patients with impaired renal function or congestive heart failure were allowed to substitute loop diuretics for the thiazide).1 Patients were initially randomised to valsartan 80 mg or amlodipine 5 mg QD for the first month (Step 1). Depending on the blood pressure response, the dosage was titrated to valsartan 160 mg or amlodipine 10 mg QD for month 2 (Step 2), followed by the addition of HCTZ 12.5 mg (month 3) and 25 mg (month 4) as necessary (Steps 3 and 4). Step 5 allowed for the free addition of other antihypertensive agents from month 5 until the end of follow-up.1 1. Mann J, Julius S. The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial o