进一步改善轻中度高血压治疗施仲伟

Telemedicine Study 进一步改善轻中度高血压治疗,上海交通大学医学院附属瑞金医院 施仲伟,Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities,Alfred A. Bove, MD, PhD Temple Univ. Medical School Philadelphia, Pa,Telemedicine study,Reported on March 30 , 2009 at ACC 2009,Objective,Lower Cardiovascular Disease Risk in Urban and Rural Underserved Communities Compare A nurse management program 4 office visits in one year vs. Nurse management plus weekly reporting of CVD risk factors via Telemedicine,Study Subjects,Rural and Urban Subjects Framingham risk score 10% No overt CVD Age 2075 Males and Females Known PCP (Personal Care Provider),Primary End-Point 5% or Greater in CVD Risk at 1 year 25% - NM, 37.5% - T,Study Protocol,388 Subjects completed the study,One Year Results,Among patients with stage 1 hypertension who used the telemedicine reporting system, SBP reduction was significantly lower.,Conclusions and Implications,A nurse management program can reduce CVD risk in medically underserved communities, However cost for this management is prohibitive Telemedicine provides additional benefit for Blood Pressure management, particularly in patients with mild to moderate HBP,Implications,Nurse Managed CVD risk reduction potentially can significantly reduce CVD morbidity and mortality However cost for this management is prohibitive Telemedicine provides a low cost complementary risk reduction tool Automated reminders via web and telephone PHR for archiving data and providing portability Timely feedback and advice for risk management,专家即刻评论,“This is one of several studies demonstrating that the combination of some form of Web-based technology plus human intervention is effective in lowering blood pressure.“,Daniel W. Jones, MD past president of AHA Dean of Univ Mississippi School of Medicine,/WebMD/english.asp?page=1&who=091e9c5e80304e3c,互联网技术和医务人员干预的结合，能有效降低血压。,上海瑞金医院施仲伟,家庭血压监测、互联网交流和药剂师参与对高血压控制的影响,JAMA 2008, 299(24):2857-2867,internet-mediated open-label crossover trial of calcium channel blockers for hypertension 互联网为中介开放交叉钙拮抗剂治疗高血压研究,i-TECHO 试验,Ryuzaki M, et al. J Hypertens, 25(11):2352-2358,回顾：另外一项以互联网为治疗辅助的研究,上海瑞金医院施仲伟,入选患者,55名门诊高血压患者 入选标准： 收缩压140 mmHg 或舒张压90 mmHg 或者目前正在使用抗高血压药物,Ryuzaki M, et al. J Hypertens, 25(11):2352-2358,上海瑞金医院施仲伟,研究目的及方法,研究目的：比较硝苯地平控释片和氨氯地平的疗效 试验设计：随机、开放、交叉研究 观察时间：每例患者均使用两种药物各6周以上 部分患者先给予氨氯地平，至少6周后换为硝苯地平 剩下患者先给予硝苯地平，至少6周后换为氨氯地平 接受两种药物治疗过程中，监测家庭自测血压情况,Ryuzaki M, et al. J Hypertens, 25(11):2352-2358,上海瑞金医院施仲伟,Ryuzaki M, et al. J Hypertens, 25(11):2352-2358,Ryuzaki M, et al. J Hypertens, 25(11):2352-2358,i-TECHO：硝苯地平控释片控制清晨血压 疗效优于氨氯地平,硝苯地平控释片组,氨氯地平组,*P0.05 vs. 氨氯地平,*,*,血压（mmHg）,60,80,100,120,140,160,133,81,131,80,收缩压,舒张压,Ryuzaki M, et al. J Hypertens, 25(11):2352-2358,上海瑞金医院施仲伟,重视轻中度高血压的治疗,我国轻中度高血压患者比例较高,Journal of Preventive Medicine ，2003；37(2):84-89,亚洲国际心血管病合作研究（interASIA）：20002001年中国3574岁成年人群统计,2007年欧洲高血压指南： 血压不高的患者同样可能处于高危状态,Giuseppe Mancia, Co-Chairperson, Guy De Backer, et al. European Heart Journal (2007) 28, 14621536.,155例原发性轻中度高血压患者 年龄3575岁 基线舒张压95105 mmHg 未用降压药物的患者：硝苯地平控释片组78.9%；氨氯地平组78.5%,Current medical research and opinion;2003;19,3:226-237,轻中度高血压多中心比较研究,研究方案及给药方法,Current medical research and opinion;2003;19,3:226-237,轻中度高血压： 两种CCB降低SBP的疗效相当,组间比较 P = NS,Current medical research and opinion;2003;19,3:226-237,拜新同 氨氯地平,积极治疗期,随访时间（周）,血压值（mmHg）,轻中度高血压： 两种CCB降低DBP的疗效相当,Current medical research and opinion;2003;19,3:226-237,组间比较 P = NS,拜新同 氨氯地平,积极治疗期,随访时间（周）,血压值（mmHg）,轻中度高血压： 拜新同组患者的停药率低于氨氯地平组,因不良反应停药的患者（%）,Current medical research and opinion;2003;19,3:226-237,轻中度高血压多中心比较研究：结论,对于轻中度高血压患者，拜新同有效降压，而且并未将血压降得过低 服用拜新同的患者停药率低于氨氯地平,Current medical research and opinion;2003;19,3:226-237,基线血压不同，拜新同的降压疗效不同,Poole-Wilson PA, et al. Lancet 2004;364:84957. MJ Brown, et al. Lancet 2000; 356:366.,注： INSIGHT使用拜新同30-60 mg； ACTION拜新同 60 mg,ADVANCE-Combi：早期血压达标，硝苯地平控释片组优于氨氯地平组,#：组间比较差异有统计学显著性,Ikuo SAITO, Takao SARUTA, Hypertension Research. 2006.29: 789-796.,ADVANCE-Combi试验： 硝苯地平控释片联合治疗组血压达标率优于氨氯地平组,提高舒张压达标率,76.8,50.2,提高收缩压达标率,43.9,提高整体达标率,组间比较P值均0.001,硝苯地平控释片联合治疗组,氨氯地平联合治疗组,Ikuo SAITO, Takao SARUTA, Hypertension Research. 2006.29: 789-796.,轻中度高血压患者： 使用拜新同的患者副作用发生率低,患者百分数（%）,Arch Intern Med. 1998;158:2029-2034.,LEAD试验：不良反应发生率 拜新同低于非洛地平缓释片,Roberta Romito, Maria Ida Pansini, Francesco