课件：降压联合治疗方案理论与实践.ppt

Slide 19: LIIFE: Comparable Blood Pressure Reductions Both losartan and atenolol substantially reduced systolic and diastolic blood pressures (-30.2/16.6 mmHg with losartan; -29.1/16.8 with atenolol).1 The target blood pressure of 140/90 mmHg was achieved by 49 % of patients treated with losartan and 46% of patients treated with atenolol.1 When adjusting for these minor differences in BP lowering, the significant reduction in risk of the combined primary endpoint of cardiovascular morbidity and mortality was not affected in any appreciable manner.1 同样的降压效果，为什么获益不同呢？恐怕就来源于降压以外的对代谢的作用。 Slide 16: LIIFE: Primary Composite Endpoint For the first time ever a combined cardiovascular morbidity and mortality primary endpoint trial in hypertensive patients has demonstrated the superiority of an antihypertensive agent, losartan, over an active comparator that is a current standard treatment for hypertension (atenolol).1 The primary endpoint of LIIFE was the composite of cardiovascular morbidity and mortality (defined as stroke, MI, and cardiovascular death.) By adjusted intention-to-treat analysis (which was the primary analysis approach of this study), losartan was superior to atenolol in reducing the risk of combined cardiovascular morbidity and mortality – a significant 13% relative risk reduction vs. atenolol (p=0.021).1 The primary result was even stronger, 14.6% (p=0.009), if not adjusted for Framingham risk score and ECG-LVH at baseline.1 No significant differences in CV death and MI vs. atenolol were observed.1 The risk reduction in CV events with atenolol was consistent with those in previous studies with beta blocker-based regimens vs. placebo, such as the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension).12 The superior risk reduction in the primary endpoint (composite of CV death, MI, and stroke) with losartan vs. atenolol in the LIIFE study suggests an important role for losartan in patients with hypertension beyond the effects of bloo