ACEI与ARB .pptx

ACEI与ARB,山东省立医院心内科韩伟中,.,Introduction,Thereninangiotensinaldosteronesystem(RAAS）maintaininghaemodynamicstabilityinthehumanbodythroughregulationofarterialbloodpressure,waterandelectrolytebalance,.,CurrentconceptoftheRAAS,.,.,RAAS:animportanttherapeutictarget,directrenininhibitor(DRI),ACEIARBaldosteroneantagonist(AA),.,.,ACEI/ARBonhypertension,.,THEBLOODPRESSUREINDEPENDENTEFFECT:ACEI,ARBORBOTH?,Anti-hypertensivetherapyhasbeenshowntoreducetheriskofstroke(3540%),myocardialinfarction(2025%)andheartfailure(50%)bloodpressureindependenteffect,wherebytheobservedcardiovascularbenefitexceedsthebenefitsthatwouldbeattributedtotheobservedreductionofbloodpressurealone,.,HOPE,EUROPA,PEACEtherewasan18%relativereductionincardiovascularmortality,MI,andstroke,despitetheachievementofonlymodestbloodpressurereductions,.,OnlyACEI,2007,JournalofHypertension,metaanalysiswhichincludedover26trials,demonstratedthatdespitecomparableblood-pressure-dependenteffectsonoverallriskofcoronaryevents,stroke,andheartfailurebetweenACEIsandARBsACEIswereassociatedwithanadditive9%relativeriskreductionofcoronaryevents,independentofareductioninbloodpressure,.,.,ARB-MIParadox,2004,VALUE,amultinationalstudyofover15000high-riskhypertensivepatientsrandomizedtovalsartanoramlodipinewhowerefollowedoverameanof4.2yearsfortimetotheprimaryendpointacompositeofcardiovascularmortalityandmorbidity,.,ARB-MIParadox,Atitsconclusion,therewasnodifferencenotedintheprimaryendpoint.VALUEreceivedaconsiderableamountofattentionforthesecondaryendpointfindingsonrateofMIbetweenthevalsartangroup(4.8%)andamlodipinegroup(4.1%)accountingfora19%relativeincreaseinriskofMI,.,Debate,Apublicizededitorialina2004issueoftheBritishMedicalJournalbyVermaandStraussThedebateplayedoutina2006issueofCirculation,inwhichtwogroupsofauthorsdebatedtheARB-MIParadox,.,.,)therewasnomajordifferenceinthecompositeprimaryoutcomeofMI,stroke,cardiovasculardeath,orall-causedeathII)analysisoftheendpointofMIalonedidnotrevealanincrementalriskofMIbetweentheARBandACEI,.,ThesefindingsallayedconcernsthatARBuseincreasedtheriskofcardiovascularoutcomesItalsofailedtodemonstrateacardioprotectiveeffectDespitethefactthatpatientsinthetelmisartanarmhadconsistentlylowermeanbloodpressuremeasurements(0.9/0.6mmHg)thanwithACEI,.,Possiblemechanisms,.,NewProgress,includedatotalof37randomizedcontrolledtrials,with147020patientsfollowedonaveragefor3.3yearscomparingcardiovascularoutcomesbetweenARBtherapyandcontroltherapies,.,CONCLUSION,ARBsandACEIbothmodulateRASactivityandangiotensinIIeffectsBlood-pressureindependenteffectwhichappearstobelongtotheACEIclass,notARB,.,CONCLUSION,ARBappeartohaveaneutraleffectuponmodifyingth