络活喜循证之路讲解课件.ppt

2 SLIDE 31 The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981-2997. 1. Mann J, Julius S. The 缬沙坦 Antihypertensive Long-term Use Evaluation (VALUE) trial of cardiovascular events in hypertension. Rationale and design. Blood Press. 1998; 7:176-183. 0.5 1.0 2.0 0.5 1.0 2.0 CV死亡+CKD进展 全因死亡+CKD进展 氨/ ACEI更好 ACEI / H更好 氨/ ACEI更好 ACEI / H更好 0.88 (0.60–1.31) 1.01 (0.76-1.35) 0.71 (0.54–0.94) 0.82 (0.67-1.00) P=0.534 P=0.943 N=100 N=183 P=0.014 P=0.047 N=217 N=382 风险比(95%) 风险比(95%) eGFR≥60 eGFR60 CKD1、2期与3期联合CV/肾脏终点的区别 CKD 非CKD (%) A/B (n=1049) H/B (n=1028) A/B (n=4686) H/B (n=4719) 低血压 3.9 4.5 2.2 3.4 晕厥 24.3 25.7 19.9 25.3 外周水肿 37.2 15.1 29.9 13.1 血管性水肿 1.3 0.5 0.8 0.6 高血钾 2.0 1.7 0.3 0.3 低血钾 0.1 0.1 0.0 0.3 副反应发生率 ACCOMPLISH研究平均随访30个月后，初始单片复方联合治疗降低患者发病率和死亡率，ACEI/CCB联合方案更受推崇 2077例3期CKD患者，虽然其中近50%的患者血压控制在130/80的目标血压以下，但其CV事件仍然显著高于1、2期CKD患者 对于CKD患者，随机药物组间CV死亡率没有差别 总 结(1) 虽无统计学差异，ACEI/CCB仍显示出更有效减缓3期CKD患者肾病进展的趋势 ACEI/CCB在降低CV死亡或全因死亡与CKD进展的复合终点具有显著优势 总 结(2) CKD队列中，50%患者实现了SBP130mmHg的目标血压 氨氯地平+贝纳普利组，早期CKD患者预设终点事件(肌酐倍增，ESRD和死亡)的发生率较低，但在晚期肾病患者中无差别 该研究结论有待其他前瞻性研究进一步证实 总 结(3) 络活喜: 循证经典,久经考验 1993 TOMHS 1994 CAPE 1996 PRAISE 2000 PREVENT 2002 2003 IDNT 2004 2004 CAMELOT 2005 2006 2008 2008 众多循证证据从各方面充分验证了络活喜临床获益 * * Byington RP, Miller ME, Herrington D, et al, for the PREVENT Investigators. Rationale, design, and baseline characteristics of the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT). Am J Cardiol. 1997;80:1087-1090. Pitt B, Byington RP, Furberg CD, et al, for the PREVENT Investigators. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation. 2000. In press. Slide 40 Slide 47 P