雅施达在慢性肾病患者的应用.pptVIP

正是因为雅施达强效、平稳、持久的降压疗效，使其具有独特的心血管保护作用，并能降低高血压患者全因死亡率。 2011年最新发布了一项荟萃分析，共纳入19项2000-2010年6月的以ACEi或ARB为治疗组，以心血管事件发病率-死亡率为终点的随机对照研究，所有研究中入组患者大部分为高血压患者（＞ 66%），主要或者次要终点包括全因死亡率。 这项荟萃分析显示，只有雅施达的三大研究，ASCOT、HYVET和ADANCE研究有显著降低全因死亡的证据，而其他RASS抑制剂，包括ACEI和ARB，迄今为止并未能获得这一证据 * 在267例慢性肾病患者中的一项研究结果表明，雅施达可使其全因死亡率下降50%； 而另一项针对终末期肾病患者的研究结果显示，雅施达可分别降低全因死亡率及心血管死亡率81%、82%。由此可见，雅施达?可显著降低慢性肾病患者死亡风险。 1. Abstract BACKGROUND: Australian Aborigines in remote areas are experiencing an epidemic of renal and cardiovascular disease. In November 1995, we introduced a renal and cardiovascular treatment program into the Tiwi community, which has a three- to fivefold increase in death rates and a recent annual incidence of treated end-stage renal disease (ESRD) of 2760 per million. Our previous study described an estimated 50% reduction in renal failure and all-cause natural deaths in the treatment group through December 31, 1998. We now describe a reduction in these events through mid 2000. METHODS: People eligible for treatment were those with confirmed hypertension, diabetics with microalbuminuria or overt albuminuria, and people with overt albuminuria, regardless of blood pressure and diabetes. Treatment centered around the use of perindopril (Coversyl, Servier), with additional agents as needed to reach defined blood pressure goals, attempts at control of glucose and lipid levels, and health education. Two hundred and sixty-seven people, or 30% of the adult population, have been enrolled, with mean follow up of 3.39 years. Rates of terminal endpoints were compared on an intention-to-treat basis with those of 327 historical controls matched for baseline disease severity, who were followed for a mean of 3.18 years in the pre-treatment program era, against a background of no treatment or inconsistent changing treatment. RESULTS: Terminal events occurred in 38 controls and 23 people in the treatment group. The estimated rate of natural deaths in the treatment group was 50% that of the controls, (P=0