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高血压合并冠心病患者的降压治疗应当适度 PowerPoint PPT Presentation


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高血压合并冠心病患者的降压治疗应当适度. 刘 健 王伟民 北京大学人民医院心内科. 高血压与冠心病. 血压的升高促使动脉粥样硬化的发生与发展 高血压患者冠心病的患病率是血压正常者的 3-4倍 60%-70% 冠心病患者有患有高血压 冠心病的心血管事件、死亡与升高的收缩压/舒张压水平正相关 高血压合并冠心病的干预治疗,降压很重要,同时须控制多种危险因素. 冠心病患者降压治疗的主要益处来自血压降低本身. 冠心病患者合并高血压的降压治疗,血压降得越低越好?. 错误!. 稳定型心绞痛患者降压治疗的益处如何?. ACTION 研究.

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高血压合并冠心病患者的降压治疗应当适度

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  • 3-4

  • 60%-70%

  • /


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Action

ACTION

  • ACoronary diseaseTrialInvestigatingOutcomewithNifedipine GITS ()

  • 20049 Lancet [ Lancet 2004;364:84957]

  • CCB


Action1

ACTION

3060mgqd

n=3,825

7,665

qd

n=3,840

0

1

2

4

5

3

6

Lubsen J, Poole-Wilson PA, Pocock SJ, et al. Eur Heart J 1998;19(suppl I):I2032.


Action2

1) :

  • PTCA

  • CABG

2) :

  • CV

  • PTCA

  • CABG

3) CV CV

ACTION


Action3

ACTION

%

(p=0.4)

1.0

0.8

(MI, RA, HF, CVA, PREV p=0.5)

(, MI, CVA, p=0.9)

0.6

0.4

RA=

PREV=

CVA =

0.2

0.0

0

2

4

6


Action4

ACTION

Franz H. Messerli, Jan A. Staessen,

The American Journal of Medicine (2005) 118, 1418-1420


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2006

  • The authors concluded that nifedipine treatment is safe and reduces the need for coronary interventions.

  • However, the lack beneficial effects of nifedipine on hard endpoints may notsatisfy the requirements for cardiovascular safety.

The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology.European Heart Journal (2006) 27, 13411381


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  • <140/90 mmHg

  • <150/90 mmHg

  • <130/80 mmHg


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The INVEST Trial

The International Verapamil-Trandolapril Study

Pepine CJ, et al. JAMA. 2003;290:2805-2816.


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  • 22576verapamiltrandolapril

  • 70

Pepine CJ, et al. JAMA. 2003;290:2805-2816.


Invest

INVEST:

SR+

Systolic Blood Pressure

Level (mmHg)

Diastolic Blood Pressure

Level (mmHg)

0

6

12

18

24

30

36

42

48

Time, mo

No. of Pts.CASNCAS

1126711309

85588573

86398694

77587710

78427850

57215834

36593679

14581473

796817

Pepine CJ, et al. JAMA. 2003;290:2805-2816


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INVEST: (MI and stroke free survival)

22576 CAD , 24

Cumulative endpoint (%)

100

95

90

85

80

75

log rank p=0.62

SR

0 6 12 18 24 30 36 42 48 54 60 66

Months

Pepine et al JAMA 2003;290:2805-2816


Invest1

INVEST

25

MI

20

15

10

5

0

130

130-140

140-150

150-160

160-170

170-180

> 180

SBPmmHg


Invest2

MI

INVEST

20

18

%

16

14

12

10

8

6

4

2

0

<60

60-70

70-80

80-90

90-100

100-110

>110

DBPmmHg


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C

INVEST

B

HOT

A

DBP65- 70mmHg


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  • 20063ACCMesserilINVEST

  • MesserliINVEST22576

Messerli,etc. Ann Intern Med 2006, 144(12):884.


Invest3

INVEST

  • SBPDBPJSBP119.2mmHgDBP84.1mmHgDBPJ

  • J

Messerli,etc. Ann Intern Med 2006, 144(12):884.


Invest4

INVEST

  • DBP84.1mmHg24

  • 6070mmHg123

  • 60mmHg2

Messerli,etc. Ann Intern Med 2006, 144(12):884.


Invest5

INVEST

  • DBPJ

Messerli,etc. Ann Intern Med 2006, 144(12):884.


Dbp 80 mmhg

DBP80mmHg


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  • 6070


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