新型固定剂量降压制剂安博诺ppt课件

1、新型固定剂量降压制剂安博诺新型固定剂量降压制剂安博诺实际与实际实际与实际降压治疗开展的总趋势降压治疗开展的总趋势 强化强化 优化优化 简化简化 降压治疗方式的历史演进降压治疗方式的历史演进 序贯治疗序贯治疗(sequential monotherapy)(sequential monotherapy) 阶梯治疗阶梯治疗(stepped-care)(stepped-care) 结合治疗结合治疗(Combination)(Combination)不同降压机制药物结合治疗的降压效应不同降压机制药物结合治疗的降压效应疗效疗效(A+B) = (A+B) = 疗效疗效(A) + (A) + 疗效疗效(B)

2、(B)疗效疗效(A+B) (A+B) 疗效疗效(2A) (2A) 或或 疗效疗效(2B) (2B) Trials testing two pressure lowering drugs separately and in combinationExpected fall in systolic blood pressure (mm Hg)Observed fall in systolic blood pressure (mmHg)0-10-20-30-40-40-30-20-100Law MR. BMJ 2003;326:1427不同降压机制药物结合治疗的不良反响不同降压机制药物结合治疗的不良

3、反响不良反响不良反响(A+B) (A+B) 不良反响不良反响(A) + (A) + 不良反响不良反响(B)(B)不良反响不良反响(A+B) (A+B) 不良反响不良反响(2A) (2A) 或或 不良反响不良反响(2B) (2B) Choose betweenLow-dose 2-drug combinationLow-dose single agentNot at BP goalFull dose ofsingle agentSwitch todifferent agentat low doseFull dose of2-drugcombinationAdd athird drugat low

4、 doseNot at BP goal23 drugcombinationat full doseFull doses of 23-drugcombinationFull-dosesingle agentMarked BP elevationHigh/very high CV riskLower BP targetMild BP elevationLow/moderate CV riskConventional BP targetTask Force for ESHESC. J Hypertens 2007;25:110587Algorithm for Treatment of Hyperte

5、nsionARBsARBs降压疗效的荟萃分析降压疗效的荟萃分析4343项研讨，项研讨，1128111281例例 DBP DBP(mmHg) (mmHg) 降压有效率降压有效率(%)(%) 单药低剂量单药低剂量 8.2-8.9 50 8.2-8.9 50 单药高剂量单药高剂量 9.5-10.4 55 9.5-10.4 55 低剂量低剂量+HCTZ 9.9-13.6 70+HCTZ 9.9-13.6 70Conlin PR, et al. Am J Hypertens. 2000;13:418 BP (mm Hg)Weir MR et al. Am J Hypertens. 2001;14:665

6、-671.BNZ + 160 mgValsartan(n = 23)HCTZ + 160 mgValsartan(n = 30)320 mgValsartan(n = 28)血容量心输出量肾血流量PRA 体位性低血压体位性低血压GFR 肾前性氮质血症肾前性氮质血症肾小管尿酸和钙的重吸收醛固酮低血钾糖耐量糖耐量LDL-C 血尿酸血尿酸血钙血钙ARB在在5959个临床实验个临床实验5852058520例运用噻嗪类利尿剂的治疗过程中例运用噻嗪类利尿剂的治疗过程中, ,发现血钾与血糖改动之间存在亲密的相关性发现血钾与血糖改动之间存在亲密的相关性(r: -0.54, 95% CI: -0.67 (r:

7、-0.54, 95% CI: -0.67 -0.36; p0.01), -0.36; p0.01), 提示防止低血钾可阻止噻嗪类利尿剂导致的新发提示防止低血钾可阻止噻嗪类利尿剂导致的新发2 2型糖尿病。型糖尿病。降压治疗继续性降压治疗继续性1.00.80.60.40.200100200300400500600700800Days after start of antihypertensive treatmentProportion of patients persistentwith treatmentSturkenboom M, et al. 15th ESH meeting, Milan,

8、 Italy, June 17-21, 20058988例新诊断高血压，平均随访治疗例新诊断高血压，平均随访治疗2年，年，Rotterdam, The NetherlandsACEI/HCTZ (n=458) vs. ACEI+HCTZ (n=297) 治疗察看治疗察看2年，比较长期治疗的依从性和继续性年，比较长期治疗的依从性和继续性Percentage of patients fully adherent to fixed-doseCombination therapy and coadministered 2-pill therapy1009080706050403020100036912

9、1518212427Months after start of therapy21%17%Percentage of patients fully adherentFixed-dose combinationCoadministration of 2 pillsThe INCLUSIVE TrialThe Irbesartan/HCTZ Blood Pressure Reduction in Diverse Patient PopulationNeutel JM, et al. J Clin Hypertens 2005;7:578-586Minimum4 weeks1,005 Uncontr

10、olledon SingleAntihypertensiveAgent8 weeksIrbesartan/HCTZ300/25 mgWeek 18Screening8 weeksWeek 10HCTZ 12.5 mg 2 weeksWeek 245 weeksPlaceboBaselineWeek 0DBP GoalSBP GoalINCLUSIVE Blood Pressure Goal Attainment at Week 18Age Group 65 years 65 yearsSBP goal (%) At Week 2 3 4 At Week 10 57 52 At Week 18

11、79 73DBP goal (%) At Week 2 27 63 At Week 10 65 86 At Week 18 78 96Am J Geriatr Cardiol. 2021;17:27Primary endpointIrbesartan150mgForce-titrate toirbesartan300mgPlacebolead-in(washout)Irbesartan/HCTZ150mg/12.5mgForce-titrate toirbesartan/HCTZ300mg/25mgRWeek 5Week 1*Change in SeSBP from Baseline (mmH

12、g)*P0.0001*Subjects with Controlled Blood Pressure (%)* P0.023; *P0.001Irbesartan Irbesartan + HCTZIrbesartan/HCTZ(n=468)Irbesartan(n=227)Schrader J, et al. Clin Drug Invest 2007;27:783-796在日常临床实际中在日常临床实际中, Irb/HCTZ治疗治疗14200例例血压未获控制的德国高血压患者血压未获控制的德国高血压患者, 察看治疗察看治疗9个月时的降压疗效和不良反响。个月时的降压疗效和不良反响。Treat-to-Target:安博诺安博诺(150/12.5)降压幅