慢性肾脏病与心血管危险张晓英课件.pptVIP

* * * Fig 1B * * * 因此今天重点介绍贝那普利延缓肾功能不全进展3项研究_AIPRI、ESBARI和ROAO三个研究，为ACEI的肾脏保护作用提供依据。 * 该研究为一项大规模、多中心、双盲、安慰剂对照的前瞻性试验 668名病人进入欧洲49个临床中心进行筛选（意大利，德国，法国） 662名病人进入安慰剂导入期 583名病人参与试验（洛汀新?组300人，安慰剂组283人） 血肌酐：1.5-4.0mg/dl(CrCI:60-30 ml/min) * 结果显示3年时贝那普利组和安慰剤组分别有31%和57%患者达到主要终点，贝那普利组主要终点危险总体降低53%。 * 在研究过程中，患者的血压都有进行性下降。 两组之间和两个亚组之间的血压下降都是相似的（P=0.26，0.18）。 * 在第2组，与安慰剂相比，洛汀新治疗使蛋白尿水平的下降更分别为20%和52%，P0.001） 第1组的尿蛋白排泄率也有明显下降，平均下降了49%（与第2组的洛汀新亚组比P=0.57） * 在第2组中洛汀新使预测的肾小球滤过率降低的风险降低了24% * * There are several potential advantages of using combination therapy for treatment of hypertension.[Stanton, 2002](/p76/col1/para3) The combination of 2 drugs with different mechanisms of action may show greater blood pressure control not only through additive but also through synergistic effects.[Stanton, 2002](/p76/col1/para5) Combination treatment may allow faster attainment of blood pressure targets as compared to monotherapy.[ESC, 2007](/p1495/col2/para2) Different mechanisms of action may provide beneficial effects on target organs beyond mere blood pressure control.[Stanton, 2002](/p76/col1/para9) There is a lower potential for side effects as lower individual drug doses are used. There is also potential for attenuation of certain class-specific adverse events.[Stanton, 2002](/p76/col1/para7,8) Additional benefits of using a fixed dose combination are improved patient compliance and potential for improved cost effectiveness.[Stanton, 2002](/p76/col1/para10;col2/para2) * * * * ACCOMPLISH has demonstrated the highest BP control rates among recent hypertension trials.[Jamerson, 2007](/p85/col1/para3) 73% patients in the ACCOMPLISH cohort achieved BP 140/90 as compared to 46.5%, 65.8% and 60.5% in the LIFE, ALLHAT and VALUE trials, respectively.[Jamerson, 2007](/p83/tableII),[Dahlof, 2002](/p999/col1/para2),[ALLHAT collaborative research group, 2002](/p2987/table3),[Julius, 2003](/p546/col2/para1) In the ASCOT-BPLA trial, overall 53% patients achieved target BP (140/90 for all hype