《新型固定剂量降压制剂安博诺与实践_张维忠》由会员分享，可在线阅读，更多相关《新型固定剂量降压制剂安博诺与实践_张维忠（31页珍藏版）》请在金锄头文库上搜索。
1、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(sequential monotherapy)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) Trials testing two pressure lowering drugs separately and in combinationExpected fall in systolic blood pressure (mm Hg)Obser
2、ved fall in systolic blood pressure (mmHg)0-10-20-30-40-40-30-20-100Line of identityLine of identityLaw MR. BMJ 2003;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) 140 mmHg, 130 mmHg in type 2 diabetes; entry criterion at each stage of the study was DBP 70-109 mmHg; mean DBP at baseline = 91.3 mmHg. Some patien
3、ts were at goal DBP at baseline. * Goal: SBP 140 mmHg, DBP 90 mmHg, except patients with type 2 diabetes: SBP 130 mmHg, DBP 80 mmHg. BP = blood pressure; DBP = diastolic blood pressure; SBP = systolic blood pressure.DBP GoalSBP GoalINCLUSIVEBlood Pressure Goal Attainment at Week 18INCLUSIVEBlood Pre
4、ssure Goal Attainment at Week 2, 10, and 18 by Age GroupAge Group 65 years 65 yearsSBP goal (%)At Week 2 3 4At Week 10 57 52At Week 18 79 73DBP goal (%)At Week 2 27 63At Week 10 65 86At Week 18 78 96Am J Geriatr Cardiol. 2008;17:27RAPiHD Severe Study Design, Results and ConclusionsStudy DesignPrimar
5、y endpointIrbesartan 150mgForce-titrate to irbesartan 300mgPlacebo lead-in (washout)Irbesartan/HCTZ 150mg/12.5mgForce-titrate to irbesartan/HCTZ 300mg/25mgRWeek 5Week 1Neutel JM et al. J Clin Hypertens 2006;8:850857* *Change in SeSBP from Baseline (mmHg)*P0.0001Neutel JM et al. J Clin Hypertens 2006
6、;8:850857Combination Therapy Achieves More Rapid Blood Pressure Reductions Compared with Monotherapy Significantly More Patients in the Combination Group Had Controlled Blood Pressure*Subjects with ControlledBlood Pressure (%)* P0.023; *P0.001 Neutel JM et al. J Clin Hypertens 2006;8:850857Irbesarta
7、nIrbesartan + HCTZSimilar Low Rates of Laboratory Marker Abnormalities Observed in Both Treatment GroupsIrbesartan/HCTZ (n=468)Irbesartan (n=227)Elevated creatinine3.01.8Elevated LFTs0.20High potassium0.61.3Low potassium00High glucose0.90High cholesterol00High uric acid0.20BP Goal Achevement in Pati
8、ents with Uncontrolled Hypertension Results of the Treat-to-Target Post-Marketing Survey with IrbesartanSchrader J, et al. Clin Drug Invest 2007;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。Reductions in diastolic BP (DBP) and systolic BP (SBP) compared with baseline at 3 a
9、nd 9 Reductions in diastolic BP (DBP) and systolic BP (SBP) compared with baseline at 3 and 9 months in patients with mild, moderate or severe hypertension months in patients with mild, moderate or severe hypertension treated with a fixed treated with a fixed combination of combination of irbesartan
10、irbesartan 150mg /HCTZ 12.5mg once daily as first-line combination therapy 150mg /HCTZ 12.5mg once daily as first-line combination therapy0 0-10-10-20-20-30-30-40-40-50-50-60-60-70-700 0-10-10-20-20-30-30-40-40-50-50-60-60-70-700 0-10-10-20-20-30-30-40-40-50-50-60-60-70-70Mild hypertensionMild hyper
11、tension (SBP 140-159 or DBP 90-99mm Hg)(SBP 140-159 or DBP 90-99mm Hg)Moderate hypertensionModerate hypertension (SBP 160-179 or DBP 99-109mm Hg)(SBP 160-179 or DBP 99-109mm Hg)Severe hypertensionSevere hypertension (SBP (SBP 180180 or DBP or DBP 110mm Hg)110mm Hg)DiastolicDiastolicSystolicSystolicD
12、iastolicDiastolicSystolicSystolicDiastolicDiastolicSystolicSystolic3 months3 months9 months9 monthsBP reduction (mm Hg)BP reduction (mm Hg)-6.1-6.1 -9.8-9.8 -15.6-15.6-20.2-20.2-11.7-11.7-14.1-14.1-23.7-23.7 -29-29-13.3-13.3 -18.5-18.5-46.7-46.7-60.5-60.5Treat-to-Target:安博诺(150/12.5)降压幅度Schrader J, et al. Clin Drug Invest 2007;27:783-796Treat-to-Target 结论 Irb/HCTZ能强效控制各种类型高血压，包括代谢综合征。 Irb/HCTZ不良反应很低，仅0.62%。 Irb/HCTZ长期治疗依从性高达92%。
