新型固定剂量降压制剂安博诺理论与实践张维忠.ppt

新型固定剂量降压制剂安博诺理论与实践,降压治疗发展的总趋势,强化优化简化,降压治疗模式的历史演进,序贯治疗(sequentialmonotherapy)阶梯治疗(stepped-care)联合治疗(Combination),不同降压机制药物联合治疗的降压效应,疗效(A+B)=疗效(A)+疗效(B),疗效(A+B)疗效(2A)或疗效(2B),Trialstestingtwopressureloweringdrugsseparatelyandincombination,Expectedfallinsystolicbloodpressure(mmHg),Observedfallinsystolicbloodpressure(mmHg),0,-10,-20,-30,-40,-40,-30,-20,-10,0,Lineofidentity,LawMR.BMJ2019;326:1427,不同降压机制药物联合治疗的不良反应,不良反应(A+B)不良反应(A)+不良反应(B),不良反应(A+B)不良反应(2A)或130mmHgintype2diabetes;entrycriterionateachstageofthestudywasDBP70-109mmHg;meanDBPatbaseline=91.3mmHg.SomepatientswereatgoalDBPatbaseline.*Goal:SBP140mmHg,DBP90mmHg,exceptpatientswithtype2diabetes:SBP130mmHg,DBP80mmHg.BP=bloodpressure;DBP=diastolicbloodpressure;SBP=systolicbloodpressure.,DBPGoal,SBPGoal,INCLUSIVEBloodPressureGoalAttainmentatWeek18,INCLUSIVEBloodPressureGoalAttainmentatWeek2,10,and18byAgeGroup,AgeGroup65years65years,SBPgoal(%)AtWeek234AtWeek105752AtWeek187973DBPgoal(%)AtWeek22763AtWeek106586AtWeek187896,AmJGeriatrCardiol.2019;17:27,RAPiHDSevereStudyDesign,ResultsandConclusions,StudyDesign,Force-titratetoirbesartan300mg,Placebolead-in(washout),Force-titratetoirbesartan/HCTZ300mg/25mg,R,Week5,Week1,NeutelJMetal.JClinHypertens2019;8:850857,*,*,*,*,ChangeinSeSBPfromBaseline(mmHg),*P0.0001,NeutelJMetal.JClinHypertens2019;8:850857,CombinationTherapyAchievesMoreRapidBloodPressureReductionsComparedwithMonotherapy,SignificantlyMorePatientsintheCombinationGroupHadControlledBloodPressure,*,*,*,SubjectswithControlledBloodPressure(%),*,*P0.023;*P0.001,NeutelJMetal.JClinHypertens2019;8:850857,Irbesartan,Irbesartan+HCTZ,SimilarLowRatesofLaboratoryMarkerAbnormalitiesObservedinBothTreatmentGroups,BPGoalAchevementinPatientswithUncontrolledHypertension,ResultsoftheTreat-to-TargetPost-MarketingSurveywithIrbesartan,SchraderJ,etal.ClinDrugInvest2019;27:783-796,在日常临床实践中,Irb/HCTZ治疗14200例血压未获控制的德国高血压患者,观察治疗9个月时的降压疗效和不良反应。,ReductionsindiastolicBP(DBP)andsystolicBP(SBP)comparedwithbaselineat3and9monthsinpatientswithmild,moderateorseverehypertensiontreatedwithafixedcombinationofirbesartan150mg/HCTZ12.5mgoncedailyasfirst-linecombinationtherapy,Treat-to-Target:安博诺(150/12.5)降压幅度,SchraderJ,etal.ClinDru