强化MAU达标优化DKD心肾保护课件.ppt

糖尿病患者降压治疗策略需满足以下要求： 有效降低糖尿病患者血压——高质量降压；对糖尿病心血管危险因素和终点事件的有利影响；对高血压糖尿病患者发挥多效性保护作用； 基于此考量，RAS阻断剂类药物(ACEI或ARB)常用作糖尿病伴高血压患者的起始降压药物，值得注意的是，国内外众多权威指南均推荐ARB类药物作为高血压伴糖尿病患者的首选用药。6 * 8. Fujino,et al Hypertension Research 2010;33:1044-1052 9. Schinichiro Miura.et al Therapeutic Research 2009;30(4):493-499 在该研究中，安博维不仅AT1受体阻断率最高，而且在48小时中的每个时间节点上阻断作用均强于缬沙坦和氯沙坦，证实安博维AT1阻断作用比缬沙坦和氯沙坦更强效、更持久。 这是安博维更强降压和全面心肾保护的坚实基础 20. Fabia MJ, et al. J Hypertens. 2007;25:1327-1336 20. Fabia MJ, et al. J Hypertens. 2007;25:1327-1336 研究设计 多中心、开放性、前瞻性、观察性研究 入选患者 38016例患者从原有降压药换为厄贝沙坦75-300mg 所有患者均无洗脱期，换药后在厄贝沙坦基础上根据血压达标情况加用其他降压药 其中16672例患者从ACEI治疗换为厄贝沙坦 评估指标 治疗3个月和6个月后蛋白尿患者比例的变化 * Slide 21 在最后一次随访中，恢复为正常尿白蛋白（20μg/min或30mg/天）的 比例在伊贝沙坦300mg组中比对照组中更多（34% VS 21%，P=0.006） 。1 1、Parving et al, 2001a. 16. Lewis EJ, et al. N Engl J Med. 2001; 345(12):851-860 Irbesartan improves endothelial function in hypertensive patients In this study, the effects on endothelial function of three ARBs – losartan 100 mg/day, irbesartan 300 mg/day and candesartan 16 mg/day – were compared in a placebo-controlled trial. The study assessed endothelial function in terms of flow-mediated brachial artery dilation in response to hyperaemia. This was assessed by ultrasound in 122 patients with mild hypertension, who were randomly assigned to receive one of the study drugs for two months. After two months of treatment, flow-mediated brachial dilation was significantly improved with all three ARBs, but not in the placebo group (p0.05 versus baseline; p0.05 versus placebo after treatment). This confirms that AT1 blockade by ARBs significantly improves endothelial function, supporting an integral role for the AT1 pathway in the early pathogenesis of atherosclerosis. While all the ARBs included in this study had beneficial effects on endothelial function, they differed with regard to their effects on platelet aggregation, as reviewed below (slide 25). Reference Koh KK, Han SH, Chung WJ et al. Comparison of effects of los