《1ACEIvsARB在冠心病的应用》-精选·课件.ppt

* 急诊入院的冠心病患者CKD的患病率显著高于择期入院的患者，陈旧性心梗的患者CKD的患病率显著高于其它患者 * 但如果我们应用基于血清肌酐、年龄、性别、体重的评估公式来测算GFR水平时，令人惊讶地发现，随着年龄的增加，到40岁以后，GFR几乎是呈线性下降的。换而言之，临床上经常作为肾功能评价指标的血清肌酐即使处于正常水平，但老年人可能已经出现GFR下降。 * * Once (WANS) the diagnosis of HTN, was established, it was necessary to qualify the following: the level or stage of HTN The presence or absence of organ-damage, The presence or absence of OTHER (poner enfasis al pronunciar esto) cardiovascular and/or renal risk factors and finally if it was necessary to look for a specific cause of THE HTN. After must never TO with the verb * 蒙诺肝肾双通道代偿排泄，肾功能不全患者使用会代偿性增加肝脏代谢，因此极少引起药物蓄积，无需调整剂量 * 以上3个ACEI用于肾功能不全患者时，蒙诺极少引起药物蓄积，培哚普利在轻度肾功能不全时就有明显蓄积，贝那普利在重度肾功能不全时也出现明显蓄积。 * 中国ACEI专家共识再次认证了蒙诺肝肾双通道代偿排泄的药理学优势，肾功能不全患者无需调整剂量，而其它的ACEI都需要减半量使用（如贝那普利、雷米普利和咪哒普利等），甚至四分之一量使用（如培哚普利） * PHYLLIS研究： 蒙诺有效延缓高血压患者的颈动脉粥样硬化进展 FAMIS研究： 早期接受蒙诺治疗，可显著减少急性心梗患者的心衰发生率，减少死亡率 FEST研究： 蒙诺显著减少心衰恶化 30 30 * 总 结 ACEI在冠心病的治疗中地位坚实，证据确凿，而ARB仅作为ACEI不能耐受时的替代 联合ACEI是冠心病患者降压治疗的优选降压方案 福辛普利（蒙诺?）是ACEI的优选 心血管保护证据可靠的ACEI 肝肾双通道代偿排泄，肾功能不全患者无需调整剂量 24小时平稳降压，真正一天一次的ACEI ????????????????????????? Thank You * Five major morbidity and mortality statin studies in primary or secondary prevention populations have been completed. This pyramid ranks the studies according to the type of patients that were included in each study. It begins with AFCAPS/TexCAPS, a primary prevention study in patients at low risk of CHD and moves to a smaller group of high-risk CHD patients in 4S, a secondary prevention study. In between the two extremes, covering the majority of patients with and at risk of CHD, are WOS, CARE, and LIPID. The Cholesterol and Recurrent Events (CARE) and Long-Term Intervention With Pravastatin in Ischaemic Disease (LIPID) studies are representative of the majority of patients with CHD, because patients in these trials had cholesterol levels that were, in general, considered to be in the average range (similar to those of the general population) rather than elevated.  * 那么，让我们来简单