单片联合制剂在高血压治疗中优势.pptVIP

Treatment Strategies in Hypertension and the Role of Single Pill Combination Yuqing Zhang Division of Hypertension, Fu Wai Hospital, CAMS PUMC Issues to Adress Antihypertensive treatment strategies: general considerations Importance of drug combinations vs strategies based on monotherapies Advantages of single pill combinations Adherence to treatment as a key factor for CV protection Choice of antihypertensive drugs Current Guidelines reconfirm that the following drug classes are all suitable for initiation and maintenance of antihypertensive treatment either as monotherapy or in some combination with each other (IA) Diuretics (thiazides / chlorthalidone / indapamide) Beta-blockers Calcium antagonists ACE-inhibitors Angiotensin receptor blockers 2013 ESH/ESC Hypertension Guidelines Relative Risk (RR) of CV Events in Trials Comparing Drug vs Control Group Law et al., BMJ 2009; 339: b1665 Thiazides -blockers ACEI ARB CA-channel blockers Specified drug better CHD RR (95% CI) Control better 1.0 2.0 0.5 Control better 1.0 2.0 0.5 Stroke RR (95% CI) CHF RR (95% CI) Control better 1.0 2.0 0.5 Trials Events 64 9031 64 10096 39 4256 Specified drug better Specified drug better Average BP  over 24 Hours (Peak and Trough) from 357 Randomized Trials (n = 40000 Treated and 16000 Placebo Patients) Law MR et al., Brit Med J 2003; 326: 1427  SBP (mmHg)  DBP (mmHg) Adverse Effects of Drugs in 357 Randomized Trials (n = 40000 Treated and 16000 Placebo Patients) Law MR et al., Brit Med J 2003; 326: 1427 % Which strategy to adopt if initial Monotherapy at standard dose Fails？ Percentage of Patients Reaching a Target SBP140 mmHg with Different Classes of Antihypertensive Agents Morgan et al., J Hypertens 2001; 14: 241-247 Placebo ACEI Beta- blockers Calcium channel blockers Diuretics Ratio of observed to expected incremental blood pressure-lowering effects* of adding a drug or doubling the dose according to the class of drug Wald DS et al., Am J Med 2009; 122: 290 * The expec