钙拮抗剂降压治疗地位进展.ppt

钙拮抗剂降压治疗地位进展

从循证证据和国际治疗指南的角度

影响不同种类降压药物治疗地位的决定因素?禁忌症?循证医学证据?不良反应和治疗持续性?效益/费用?种族

各类降压药物的禁忌症(ESC/ESH,2007) 噻嗪类利尿剂痛风代谢综合症、糖耐量减低妊娠?-阻滞剂哮喘、外周血管病、代谢综合症糖耐量异常、慢阻肺A-V阻滞(2或3度)运动员和强体力活动者二氢吡啶类CCB——快速性心律失常、心力衰竭非二氢吡啶类CCBA-V阻滞(2或3度)心力衰竭ACEI和ARB妊娠、高血钾症双侧肾动脉狭窄醛固酮拮抗剂肾功能衰竭高血钾症绝对(强制)相对(可能)

SBPdifferencebetweenrandomizedgroups(mmHg)Relativeriskofoutcomeevent1.501.251.000.750.500.251.501.251.000.750.500.251.501.251.000.750.500.251.501.251.000.750.500.251.501.251.000.750.500.25StrokeMajorCVDCHDCVDdeathTotalmortality-10-8-6-4-2024-10-8-6-4-2024-10-8-6-4-2024-10-8-6-4-2024-10-8-6-4-2024BP-LoweringTreatmentTrialists(WHO/ISH,2003)BloodPressureLoweringTreatmentTrialists’Collaboration.Lancet.2003;362:1527-1535.

0.51.02.0RelativeRiskRR(95%CI)BPDifference

(mmHg)Favors

FirstListedFavors

SecondListedMajorCVeventsCVmortalityTotalmortality1.02(0.98,1.07)2/0ACEIvsD/BB1.03(0.95,1.11)2/0ACEIvsD/BB1.00(0.95,1.05)2/0ACEIvsD/BB1.04(0.99,1.08)1/0CAvsD/BB1.05(0.97,1.13)1/0CAvsD/BB0.99(0.95,1.04)1/0CAvsD/BB0.97(0.92,1.03)1/1ACEIvsCA1.03(0.94,1.13)1/1ACEIvsCA1.04(0.98,1.10)1/1ACEIvsCABloodPressureLoweringTreatmentTrialists’Collaboration.Lancet.2003;362:1527-1535.BP-LoweringTreatmentTrialists

ComparisonsofDifferentActiveTreatments

RR(95%CI)FavoursfirstlistedFavourssecondlisted0.51.02