高血压、冠心病循证医学结果课件.pptVIP

This shows the overall benefit of treatment. There are large reductions in deaths from stroke, CHD and vascular disease, but not increase in death from other causes. This shows the overall benefit of treatment. There are large reductions in deaths from stroke, CHD and vascular disease, but not increase in death from other causes. A total of 719 centers participated in ASCOT, including 686 general practices in Denmark, Finland, Iceland, Norway, and Sweden and 33 regional centers in Ireland and the UK. ASCOT employs a 2x2 factorial design, which allows 2 hypotheses to be tested simultaneously. The first hypothesis tested is whether a newer antihypertensive regimen (calcium channel blocker [CCB] ± an angiotensin-converting enzyme inhibitor [ACE]) is more effective than a standard regimen (?-blocker ± a diuretic) in the primary prevention of CHD in hypertensive patients. The second hypothesis tested is whether a statin, compared with placebo, would provide protection against CHD endpoints in hypertensive subjects with normal to moderately elevated levels of TC (?6.5 mmol/L [?250 mg/dL]). The ASCOT study is structured in the following manner (target numbers): An estimated sample size of 18,000 patients was required to generate 1150 primary endpoints, giving the study 80% power to detect treatment effects. Of these 18,000 patients, 9000 were randomized to receive therapy with a CCB (amlodipine) ± an ACE (perindopril) and 9000 were randomized to a ?-blocker (atenolol) ± a diuretic (bendroflumethiazide+potassium). Of the approximately 9000 patients randomized to the ?-blocker ± diuretic arm, 5000 patients were expected to have TC levels of ?6.5 mmol/L (?250 mg/dL) and 4000 patients were expected to have TC levels of 6.5 mmol/L (250 mg/dL). Approximately 500 patients with TC ?6.5 mmol/L (?250 mg/dL) were assigned to open lipid-lowering therapy; the remaining 4500 patients were randomized to therapy with atorvastatin 10 mg/d or placebo. Similarly, of the 9000 patient