高血压合理用药探讨讲解课件.ppt

Dr John McMurray (University of Glasgow, Scotland) 点评: ONTARGET、 VALIANT 试验均显示 , ARB合用ACEI 并无额外获益，甚至增加不良反应. 这与Val-HeFT及CHARM所显示的合用2药可增加获益的结果形成对比， 但应注意这2个心衰试验并未在所有患者使用全剂量（ full dose）的ACEI, 故未能肯定合用益处是来自心衰条件还是ACEI 的品种或剂量等用法方面。 ONTARGET—2008ACC Dr Salim Yusuf (McMaster University, Hamilton, ON)评论: “该研究具有重要的的临床价值，因为它显示，替米沙坦是一个与雷米普利同样安全有效的可替换药物，这意味着给医生和病人合理选药提供了更有信心的选择机会。” This study is of clinical importance because it demonstrates that telmisartan is an effective and safe alternative to ramipril. This means both patients and physicians have choices and can use telmisartan where appropriate with a high degree of confidence." ONTARGET—2008ACC 15,000 例近期缺血性卒中患者 32个国家, 600 个研究中心 全世界最大规模卒中二级预防研究 2项主要分析内容: 替米沙坦＋标准抗血小板治疗 vs 标准抗血小板单药治疗 缓释双嘧达莫（ER-DP）+ 阿司匹林 vs 氯吡格雷 治疗4年 主要终点：至卒中再发的时间(目标是 2,280次卒中) 有效避免再次卒中的预防方案 The PRoFESS Collaborative Group. Presented at the 30th ISC, New Orleans, USA. 2005 大规模随机化临床试验研究 课题号：2006BAI01A01 1）人群；2）改善生活方式；3）临床试验：替米沙坦、吡格列酮 卫生部心血管病防治中心 中国医学科学院阜外心血管病医院 代谢综合征的发病趋势及综合控制研究全国协作组 江苏万邦生化医药股份有限公司资助 国家“十一五”科技支撑计划项目 PERISCOPE: Pioglitazone Prevents Atherosclerosis Progression in Diabetics ----2008ACC In PERISCOPE, 543 patients with type 2 diabetes underwent coronary IVUS and then were randomized to receive either glimepiride (1 - 4 mg) or pioglitazone (15 - 45 mg) for 18 months, at which time IVUS studies were repeated. According to study investigators, mean percent atheroma volume decreased by 0.16% in pioglitazone-treated subjects but increased by 0.73% in glimepiride-treated patients. When the analysis was repeated to include patients who had not completed the study, the results also showed an increase for glimepiride and a decrease for pioglitazone. Both agents lowered glycohemoglobin and fasting insulin levels, although pioglitazone's effects on these end points were statistically greater. Pioglitazone also produced statistically meaningful changes in high-density lipoprotein (HDL) and triglyceride levels. PERISCOPE: Change fr