络活喜大型临床研究解读精编PPT课件.ppt

The mean sitting systolic and diastolic BP for patients in each treatment arm are shown. At baseline, the average BP was 128.9/77.6 mm Hg in the placebo group, 128.9/77.2 mm Hg in the enalapril group, and 129.5/77.7 mm Hg in the Norvasc group.5 There were significant decreases in BP between Norvasc and placebo, and between enalapril and placebo, at all time points in the trial.5 During the 24-month follow-up, the overall mean reduction for Norvasc was -4.8/2.5 mm Hg; the overall mean reduction for enalapril was -4.9/2.4 mm Hg; in the placebo group, BP increased 0.7/0.6 mm Hg. There was no statistically significant difference between the Norvasc and enalapril groups.5 5. Nissen SE, Tuzcu EM, Libby P, et al, for the CAMELOT Investigators. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA. 2004;292:2217-2226. 这张幻灯片显示了3组主要复合终点心血管不良事件累积发生率的结果。5 从图中可以看到，黄线的络活喜组有16.6%的患者发生了主要心血管不良事件，白线的安慰剂组有23.1%的患者发生了主要心血管不良事件，红线的依那普利组有20.2%的患者发生了主要心血管不良事件。 络活喜与安慰剂比较，发生心血管不良事件的相对风险明显降低31%，有显著性差异，P=0.003。络活喜与依那普利比较，发生心血管不良事件的相对风险降低19%，差异无统计学意义，P=0.10。5 而依那普利与安慰剂比较，发生心血管不良事件的相对风险降低15%，差异无统计学意义，P=0.16。5 可见，经过阿司匹林、 β-受体阻滞剂和他汀类药物充分治疗的冠心病患者，加用络活喜后有显著的进一步心血管获益，而加用ACEI依那普利获益不大，统计学没有差异。 对比了IVUS技术和QCA技术后，我们来看看NORMALISE研究的结果。 从这张幻灯片左边的图可以看到，行IVUS 检查的所有患者(N=274)中，络活喜组动脉粥样硬化斑块体积百分比(PAV)的平均改变为0.5%，依那普利组为0.8%，安慰剂组为1.3%。每组各自与基线的配对分析显示安慰剂组粥样斑块有明显进展(P=0.001)，依那普利组有进展的趋势(P=0.08)，而络活喜组粥样斑块无进展 (P=0.31)。络活喜组和安慰剂组患者组间比较，PAV的平均改变无统计学差异，P=0.12。5 但从右图我们可以看到，在基线血压高于均值的亚组患者(N=136)中, 络活喜组与安慰剂组相比，PAV的平均改变分别为0.2%和2.3%，二组相比有显著性差异，P=0.02。说明络活喜能显著减缓这些患者粥样斑块的进展。5 5. Nissen SE, Tuzcu EM, Libby P, et al, for the CAMELOT Investigators. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA. 2004;292:2217-2226. 前面的研究证实了络活喜的肾脏保护作用，那么您一定也会关心一种降压药物对于肾病这一特殊患者群体的心血管保护作用，因为肾病患者也是心血管时间的高危