抗高血压治疗的新视点 ppt课件.pptVIP

* Peripheral edema with calcium channel blockers (CCBs) is explained by a greater dilation of the arteriolar rather than the venous circulation, giving rise to an increased transcapillary gradient and capillary leakage. The addition of a renin angiotensin system blocker, such as an angiotensin receptor blocker, helps negate this effect because they cause dilation of both arterial and venous capillary beds, thus bringing transcapillary pressure back to normal. This reduces the likelihood of CCB-induced edema. Notes: Peripheral edema is not related to volume overload. Adding a diuretic does not help solve CCB-induced peripheral edema. Reference Messerli FH. Vasodilatory edema: a common side effect of antihypertensive therapy. Am J Hypertens 2001;14:978–9. * * * * * 怎样？ * * * * * *  * * * * * * * * * * * 目前的主要矛盾 家测血压 * * * * * * * * Hyvet研究 Ascot，acomplish * * * * * * * * * * Short-acting dihydropyridine calcium channel blockers (DHP-CCBs) are associated with various side effects including: flushing, tachycardia, angina, dizziness and headache. The long-acting DHPs, such as amlodipine, tend to avoid these effects, but are associated with dose-dependent peripheral edema. Peripheral edema is caused by a mismatch between arteriolar and venous dilation. Arterial dilation is responsible for the reduction in BP with CCBs. However, without comparable venous dilation, capillary pressure may increase, leading to leakage of fluid into the extracellular space, thereby resulting in edema. References Messerli FH. Vasodilatory edema: a common side effect of antihypertensive therapy. Am J Hypertens 2001;14:978–9. Weir MR. Incidence of pedal edema formation with dihydropyridine calcium channel blockers: issues and practical significance. J Clin Hypertens 2003;5:330–5. 启动高血压药物治疗 2007年ESC指南： 正常高值血压、糖尿病： 目前没有证据 正常高值血压、心血管事件史： 目前没有证据 影响指南降压目标值的临床研究－糖尿病人群的研究 SBP（mmHg） 获益 无获益 部分获益 ABCD HT NT IDNT IR AM 148 154 156 143 162 138 137 144