课件：AF与STROKE的相关性及防治对策.ppt

有效降低死亡和卒中患者受益更多 在高血压合并左室肥厚的AF的患者中，在降低心血管发病率和死亡率的主要联合终点以及卒中和心源性死亡的危险方面，基于氯沙坦的治疗比基于阿替洛尔的治疗更有效 与传统的抗高血压和抗心律失常的治疗相比，无需β受体阻滞剂控制心率的高血压合并AF的病人从基于氯沙坦的治疗中受益似更多 J Am Coll Cardiol 2005;45:705–11 药物治疗有效减少房颤 Val-HeFT: 安慰剂组新发房颤＝7.86% 缬沙坦组新发房颤＝5.27% RRR＝35%，p＝0.0002 LIFE: 阿替洛尔组新发房颤221例，10.1/1000病人年 氯沙坦组新发房颤150例，6.8/1000病人年 相对危险 0.67 [95% CI 0.55-0.83], p0.001 J Am Coll Cardiol 2005;45:712-9) 氯沙坦减少新发房颤 J Am Coll Cardiol 2005;45:712-9 33% 0 6 12 18 24 30 36 42 48 54 60 66 0 1 2 3 4 5 6 7 8 Time (months) Proportion of patients with first event (%) Atenolol Losartan 相对危险 0.67 [95% CI 0.55-0.83], p0.001 小结 高血压的高危患者更易发生脑卒中，需要积极识别高危患者 LVH和AF患者是脑卒中的高危患者 有效逆转LVH可显著减少AF LIFE证实 氯沙坦同等控制血压，较阿替洛尔有效减少AF患者脑卒中的发生率 同时减少新发AF的发生 AF防治对策进展 原则 尽可能去除致老年Af危险因素 　　　　　　　　　　　　　 积极控制老年Af 致脑梗危险因素 致死↓ 致残↓ 最大程度预防心衰，脑梗的发生 生活质量↑↑ 及再发 高度重视VD的防治 * * In a prospective study involving 430 patients with essential hypertension, evaluated by 24-hour ABPM, LVM regression during antihypertensive therapy was a favourable prognostic marker for fewer cardiovascular events (new-onset coronary artery disease [myocardial infarction or angina], stroke, transient ischaemic attack, aorto-iliac occlusive disease, retinal artery thrombosis, hospitalization for progressive heart failure or renal failure requiring dialysis).1 Among the patients with echocardiographic LVH (125 g/m2) at the start of the study, the cardiovascular event rate was considerably lower in the subgroup whose LVH regressed with antihypertensive treatment than in the subgroup of patients whose LVH did not regress (1.6 vs 6.3 events per 100 patient-years; P=0.002). 1. Verdecchia P, et al. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation 1998;97:48–54. * A more recent meta-analysis evaluating the effect of di