课件：钙拮抗剂在高血压治.ppt

* Epidemiologic data has established for some time that hypertensive patients are at increased risk for developing CHD compared to their normotensive counterparts. Specifically, data from Framingham as well as others have shown that patients with blood pressures 140/90 mm Hg are 2-4x more likely to develop cardiovascular disease than patients with blood pressures 140/90 mm Hg. These epidemiologic observations directed investigators to examine the effects of drug therapy on clinical events. Data from one of the earliest trials in 1971, the VA Study, showed that reductions in blood pressure through intervention can significantly decrease the risk of a cardiovascular event in the hypertensive patient. It was around this time (1970s) that the National Heart Lung and Blood Institute administered a committee (JNC) to issue guidelines as well as increase awareness, prevention, treatment and control of hypertension. The JNC guidelines have continued to evolve over the last 30 years with further clinical trials and epidemiological observations. An example of this is seen in the next slide. Framingham Study: 6-year follow up looking at the incidence of MI, angina, sudden death in patients 45-59 years of age. CHD Incidence in normotensive men 41.4 versus CHD Incidence in hypertensive men 123.7, a 2.6 fold increase. CHD Incidence in normotensive women 8.5 versus CHD Incidence in hypertensive women 78.5, a 6-fold increase. VA Study II: 380 VA patients with mild to moderate hypertension. Average follow-up was 3.9 years. Cumulative fatal and non-fatal endpoints included MI, sudden death, subarachnoid hemorrhage, changes in fundi. Treatment included HCTZ 50 mg po BID plus reserpine 0.1 mg po BID or hydralazine 25 mg po TID (with potential to increase to hydralazine 50 mg po TID). * * 2005年发表在著名的HYPERTENSION杂志上的另一个荟萃分析也告诉了我们同样的结论。CCB和ACEI相比，对于脑卒中的事件降低更优秀。（左边是ACEI的临床研究荟萃分析，右边是CCB的临床研究荟萃分析） 图解： 横坐标：代表ACEI或者CCB相对于对照组的收缩压的差值，横坐标0右边代表ACEI或者CCB收缩压降低更好，左边则是对照组更好 纵坐标：代表卒中事件的相对风险，1的