降压治疗研究新动向

降压治疗研究新动向 强化、优化和简化 扩展降压治疗能获益的人群 ，当前 主要聚焦 在 80岁以上高龄高血压患者和 血压水平 160 4.80 5.40 8.40 1.701.20.702.22 4.81 1.60 Reference 1.2 100 80 60 40 20 0 5.5 mmol/L 3.32 5.67 1.71 (1.48-1.98) 0.0001 SAE renal failure 0.28 0.64 2.27 (1.40-3.67) 0.0006 Need for dialysis 0.55 0.78 1.42 (0.98-2.06) 0.066 Death after renal dysfunction 1.84 2.21 1.20 (0.97-1.48) 0.087 *local definition ONTARGET:Renal Dysfunction Dialysis 366:895-906. ASCOT-BPLA:终点事件发生率 累计事件发生率（ %） HR (95% CI): 0.80 (0.72, 0.90) (天 ) P = 0.0002 ACEI / HCTZ CCB / ACEI 650 526 Kenneth Jamerson, et al. Late Breaker presentation at ACC 2008. ACCOMPLISH: 心血管复合终点 20% ACCOMPLISH: 意义 对特定人群选择优化的 降压治疗方案 提供了 循证证据。 ACEI / CCB联合特别有利于减少冠心病事件 ( 心肌梗死、不稳定性心绞痛、血运重建 )。 在优化的基础上， 简化降压治疗模 式 ,寻找强效、快捷、平稳和安全的联 合治疗方案和途径。 新动向 (三 ) 降压治疗模式的历史演进 序贯治疗 (sequential monotherapy) 阶梯治疗 (stepped-care) 联合治疗 (Combination) Choose between Low-dose 2-drug combinationLow-dose single agent Not at BP goal Full dose of single agent Switch to different agent at low dose Full dose of 2-drug combination Add a third drug at low dose Not at BP goal 23 drug combination at full dose Full doses of 23-drug combination Full-dose single agent Marked BP elevation High/very high CV risk Lower BP target Mild BP elevation Low/moderate CV risk Conventional BP target Task Force for ESHESC. J Hypertens 2007;25:110587 Algorithm for Treatment of Hypertension(ESH/ESC) TALENT study STudy EvALuating the Efficacy of Nifedipine GITS - Telmisartan in Blood Pressure Control i) Nifedipine GITS 20 mg then add Telmisartan ii) Telmisartan then add Nifedipine iii) Nifedipine / Telmisartan combination Percentage of patients fully adherent to fixed-dose Combination therapy and coadministered 2-pill therapy 100 90 80 70 60 50 40 30 20 10 0 0 3 6 9 12 15 18 21 24 27 Months after start of therapy 21% 17% Percentage of patients fully adherent Fixed-dose combination C