基于临床试验高血压治疗策略.pptVIP

Hypertension Treatment Strategy Based on Clinical Trials Liu Lisheng Is antihypertensive treatment beneficial? Trials of active treatment vs. placebo (or more vs. less) When should drug treatment start? (BP level? Mild hypertension? Risk stratifications?) Whom should be treated? (Severe, mild, ISH) To what extent? Is BP lowering by different antihypertensive agents equally beneficial? Necessity of Conducting Large-scale Clinical Studies using Asian Subjects Trials Comparing Different Active Antihypertensive Agents is Difficult Because: Smaller relative benefits to be expected. Hence, large sample size, high risk pts. need to be randomized. Is antihypertensive treatment beneficial? Trials of active treatment vs. placebo (or more vs. less) When should drug treatment start? (BP level? Mild hypertension? Risk stratifications?) Whom should be treated? (Severe, mild, ISH) To what extent? Is BP lowering by different antihypertensive agents equally beneficial? Necessity of Conducting Large-scale Clinical Studies using Asian Subjects Morbidity Mortality of CVD in Asian Countries Past Large-scale Clinical Studies on Asian People Syst. - China Active treatment, stroke ? 38% (p=.01). All CVD end points ? 37% (p=.004) and total mortality ? 39% (p=.003). 1,000 Chinese pt. for 5yr prevent 39 strokes 59 major CVD complications, or 55 death. The benefit was particularly evident in diabetic pts. Effects of Antihypertensive Treatment in 4 Clinical Trials in China Are ALLHAT VALUE Applicable to Asian People? ALLHAT Long acting CCBs are safe BP lowing is most important Combination therapy is often necessary Amlodipine is the first choice for preventing stroke What do We Expect for Future Large-scale Clinical Studies Compare different combinations in stead of single drug Easy to be conducted in daily practice Intermediate end-point include TOD markers, MA, PWV, 24hrABPM, LVH, should be monitored New onset DM is an impor