临床如何选择B受体阻滞剂-Final课件.ppt

BPLTT: Blood Pressure Lowering Treatment Trialist Collaboration ASCOT Anglo-Scandinavian Cardiac Outcomes Trial Reference(s)：(a) J Hypertens 1998;16 Suppl 2:S212 (b) Lancet 2003;361:1149–58 (c) Lancet 2005;366:895–906 Disease：Hypertension Purpose：To assess and compare the effects on nonfatal MI and fatal coronary heart disease of a beta-blocker with or without a diuretic vs a calcium antagonist with or without an ACE inhibitor in hypertensive patients, and of atorvastatinvs placebo in hypertensive patients with dyslipidaemia. Study design: Antihypertensive arm: randomised, parallel-group, 2 × 2 factorial. Lipid-lowering arm: double-blind, placebo-controlled, 2 × 2 factorial Follow-up: 5 years or 1150 primary endpoints Patients: Antihypertensive arm: 19,257 patients (9639 amlopidine, 9618 atenolol), mean age 63 years, with BP?≥ 160/100 mm Hg untreated or?≥ 140/90 mm Hg treated and?≥ 3 of 11 specified cardiovascular risk factors Lipid-lowering arm: 10,305 patients (5168 atorvastatin, 5137 placebo), with total blood cholesterol?≤ 6.5 mmol/l and a total cholesterol to HDL cholesterol ratio?≤ 4.5 Treatment regimen: Antihypertensive arm: atenolol with or without a diuretic, or amlodipine with or without an ACE inhibitor, titrated to target BP < 140/90 mm Hg. Lipid lowering arm: atorvastatin, 10 mg/day, or placebo.Concomitant therapy: Doxazosin GITS at the discretion of the physicianResults: Antihypertensive arm: primary events of nonfatal MI plus fatal coronary heart disease occurred in 4.5% of patients in the amlodipine group compared to 4.9% of patients in the atenolol group (hazard ratio 0.90, 95% CI 0.79?1.02; p = 0.1052) Lipid-lowering arm: primary events of nonfatal MI plus fatal coronary heart disease occurred in 1.9% of patients in the atorvastatin group compared to 3.0% in the placebo group (hazard ratio 0.64, 95% CI 0.50?0.83; p = 0.0005) ALLHAT Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial Reference(s): (a) Am J Hypertens 1996;