β受体阻滞剂在高血压治疗中意义.ppt

β受体阻滞剂在高血压治疗中的意义 北京协和医院心内科 严晓伟 血压的控制 2006年NICE高血压指南新确诊高血压患者选择药物流程图 Reappraisal of European guidelines on hypertension management Box 5. Choice of antihypertensive drugs (1) Large-scale meta-analyses of available data confirm that major antihypertensive drug classes, that is,diuretics, ACE inhibitors, calcium antagonists, angiotensin receptor antagonists, and b-blockers do not differ significantly for their overall ability to reduce BP in hypertension. Reappraisal of European guidelines on hypertension management Box 5. Choice of antihypertensive drugs (2) There is also no undisputable evidence that major drug classes differ in their ability to protect against overall cardiovascular risk or cause-specific cardiovascular events, such as stroke and myocardial infarction. The 2007 ESH/ESC guidelines conclusion that diuretics, ACE inhibitors, calcium antagonists, angiotensin receptor antagonists, and b-blockers can all be considered suitable for initiation of antihypertensive treatment, as well as for its maintenance, Reappraisal of European guidelines on hypertension management Box 5. Choice of antihypertensive drugs (4) Each drug class has contraindications as well favorable effects in specific clinical settings. The choice of drug(s) should be made according to this evidence. The traditional ranking of drugs into first, second, third, and subsequent choice, with an average patient as reference, has now little scientific and practical justification and should be avoided. Reappraisal of European guidelines on hypertension management Box 6. Combination therapy (6)Despite trial evidence of outcome reduction, the β-blocker/diuretic combination favors the development of diabetes and should thus be avoided, unless required for other reasons, in predisposed patients. Reappraisal of European guidelines on hypertension management Box 7. Antihypertensive treatment in the elderly (2) Data from meta-analyses do not support the claim that antihypertensive drug classes sig