新版高血压与糖尿病肾病停顿课件.ppt

Hypertension and Diabetic Kidney Disease Progression;Disclosure of Relationships with Commercial Companies:;Increasing Prevalence of Diagnosed Diabetes in US Adults ;Increasing Prevalence of Obesity* Among US Adults ;Walking the dog;Incidence of Kidney Failure per million population, 1990, by HSA, unadjusted;Incidence of Kidney Failureper million population, 2000, by HSA, unadjusted;Diabetes:The Most Common Cause of ESRD;Cardiovascular Comorbidities, 5% Medicare sample, by Diabetes and CKD status, 1999-2000;Level of Kidney Function Is an Independent Risk Factor For CV Risk;Go, A. S. et al. N Engl J Med 2004;351:1296-1305;CKD Hospitalization Rates for Cardiovascular Disease;CKD Prevalence in US (AJKD 2002);CVD Risk Factors;Microalbuminuria;Proteinuria Predicts Stroke and CHD Events in Type 2 Diabetes;Berton G et.al. Diabetologia, Aug. 2004;0;;Clinical Trials and Renal Outcomes Based on Proteinuria Reduction;IDNT Proportion of Patients with the Primary Composite Endpoint*;Relationship Between Rate of Decline in Renal Function and Change in Proteinuria in IDNT;RENAAL; Baseline Proteinuria as a Determinant for Cardiac Events in Type 2 diabetes;;De Zeeuw D, et al. Kidney Int. 2004; 65:2309.;De Zeeuw D, et al. Circulation. 2004;110:921.;Most Common Cause of Failing to Reduce Proteinuria with ACE Inhibitor or ARB;What is the Goal BP and Initial Therapy in Kidney Disease or Diabetes to Reduce CV Risk?; ; ;Effects of ACE Inhibitors or ARBs on Renal Disease Progression: A Meta-Analysis Cases J et.al. Lancet 2005;366:2026;Effects of ACE Inhibitors or ARBs on Renal Disease Progression: A Meta-Analysis Cases J et.al. Lancet 2005;366:2026;-9.4;Tarif N and Bakris GL. IN: Johnson R and Freehally J (eds.) Principles of Nephrology Mosby Co. London, 2000 pp. 40.1-12, Ashgar A Bakris, G Primer in Kidney Disease, 2005 ;General Concept;Intensive Multiple Risk Factor Management;Saydah S et.al JAMA 2004;291:335;(if systolic BP 20 mmHg above goal) START with ACEI or ARB/thi