Hypertension Evidence The Gold standard课件.ppt

Hypertension Evidence and CHS Guidelines2005 Evidence Evolution Hard end-points Mortality CVD events Cerebrovascular events PVD events CHF Progression to ESRD Surrogate end-points Rising CR Progression to proteinuria Progression/regression of micro-albuminuria Evidence Evolution MRC-1985 HAPPHY-1987 EWPHE-1991 STOP-1991 SHEP-1991-4 STONE-1996 SYS-EUR-1997 SYS-CHINA-1996-98 HOT-1998 UKPDS -1998 CAPPP-1999 STOP 2 -1999 HOPE -2000 MICRO-HOPE -2000 INSIGHT -2000 NORDIL -2000 CALM -2000 INDT -2001 IRMA -2001 RENAAL -2001 PROGRESS -2001 LIFE-2002 SCOPE 2002 ALLHAT 2002 CHS Guideline Evolution 2002 Impact of the ALLHAT - 2002 Consideration of PROGRESS - 2001 IDNT - 2001 RENAAL - 2001 ANBP2 - 2003 Guideline Evolution 2004 Hypertension ALLHAT - 2002 LIFE - 2002 ANBP2 - 2003 OPTIMAAL - 2002 EPHESUS - 2003 CHARM - 2003 Psaty-Network meta-analysis Law Meta-analysis Staessen Meta-regression analysis Post stroke PROGRESS - 2001 ASA and Statins HOT - 1998 ASCOT-LLA - 2003 PROSPER - 2002 HPS - 2002 ALLHAT-LLT - 2002 CHS January 2004Indications for drug therapy in adults with hypertension without compelling indications for specific agents: Strongly consider antihypertensive therapy if DBP ≥ 90 with TOD or CV risk factors Elevated SBP, smoking, dyslipidemia, strong FH CAD, truncal obesity, sedentary lifestyle Rx antihypertensive therapy for DBP ≥ 100 or SBP ≥ 160 without TOD or CV risk factors Rx statin therapy in HTN patients 40 yr of age with 3 or more CV risk factors or established atherosclerotic disease Strongly consider low dose ASA in HTN patients 50 yr of age. (Caution if BP not controlled) Cardiovascular risk factors for consideration of statintherapy in non-hyperlipidemic patients with hypertension(derived from ASCOT-LLA) Male Age 55 years or older Left ventricular hypertrophy Other electrocardiogram abnormalities: left bundle branch block, left ventricular strain pattern, abnormal Q waves or ST-T changes compatible with ischemic heart disease Periphe