从指南看看24小时血压控制-美卡素

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,*,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,24,小时血压控制,美卡素降压持久稳定,诊室外血压越来越得到关注,过去几年以来，越来越多的研究证据证明监测,诊所外血压,的重要性，对于某些看似血压正常的个体，诊所外血压的监测能更精确地反映他们高血压的严重程度，进而甑别出具有危险因素的人群。,一项大型临床研究证明，对于,诊所血压,、家庭,自测血压,、,24,小时,动态血压,都正常的受试者，随着这三种血压检测方法中的一种、两种或三种检测出高血压，这些患者在,12,年死亡的危险也呈进行性的增加。,2007,年欧洲高血压指南,1,、,杓型血压,2,、,非杓型血压,3,、,超杓型血压,4,、,反,杓型血压,5,、,晨起高血压,24,小时血压波动的常见类型,夜间血压变化,10%-20%,20%,夜间血压高于,白天血压,5%,晨起血压高于夜间,平均血压的,30%,夜间与清晨血压,对预后的评估，夜间血压的价值高于诊所血压。夜间血压控制不良的患者，更易发生靶器官损害，预后更差；,清晨是心脑血管事件发生的高峰期，这可能与血压在晨醒后的陡然升高，血小板凝集性增加，纤溶活性的降低以及交感活性的增强有关。,2007,年欧洲高血压指南,24,小时,ABPM,比诊所血压更好预测危险性,160,24,小时动态,SBP 135 mmHg,24,小时动态,SBP 135 mmHg,诊所收缩压(,mmHg),每 1,000人年事件数,0,5,10,15,20,25,Clement et al.,N Engl J Med,2003;348:24072415,Dublin,预后研究,:24,小时动态血压预测心血管死亡危险优于诊室血压,Eamon Dolan et al.Hypertension 2005;46:156-161,3.5,2.2,收缩压,舒张压,5,年心血管死亡危险,%,90,110,130,150,170,190,210,230,0.5,1.0,1.5,2.0,2.5,3.0,50,60,70,80,90,100,110,120,0.7,1.0,1.3,1.6,1.9,130,夜间血压,24,小时动态血压,日间血压,诊室血压,夜间血压,24,小时动态血压,日间血压,诊室血压,5 292,例未经治疗的高血压患者于同一个高血压门诊进行基线动态血压监测，,然后进行,8.4,年的随访。夜间动态血压是心血管死亡的独立预测因子,血压晨峰现象,时间,18:00 22:00 02:00 06:00 10:0,0,14:00,18:0,0,晨醒,时间,睡眠,180,160,140,120,100,80,Millar-Craig et al.,Lancet,1978;1(8068):795,797,Mancia et al.,Circ Res,1983;53:96104,24小时,血压变化,血压(,mm Hg),清晨血压,高峰,6:00,0:00,12:00,18:00,Muller et al.,N Engl J Med,1985;313:13151322,Marler et al.,Stroke,1989;20:473476,时间,血压晨峰现象,心血管危险性升高,0,20,40,60,80,100,120,140,160,180,脑血管事件,(,每,2 h),0,5,10,15,20,25,30,35,40,45,50,心肌梗死,(,每,h),卒中,(n=1,167),心梗,(n=2,999),分析急性心肌梗死,(n=2,999),或卒中,(n=1,167),发作2项研究的昼夜节律的数据,不同时段血压升高,日间,清晨,夜间,总心脑血管死亡危险,出血性脑卒中死亡危险,脑梗塞死亡危险,缺血性心脏病死亡危险,Hirohito Metokia,et al.J Hypertens 2006.24:18411848.,Ohasama,研究结论,:,心脑血管死亡危险均与清晨高血压显著相关,晨峰高危时段血压控制不良状态,Redn et al.,Blood Press Monit,2002;7:111116Kario et al.,Circulation,2003;108:72e73e,Not controlled,Controlled(morning BP 6,500 例患者,32 个国家,血压晨峰,美卡素,vs,雷米普利,美卡素终末靶器官保护的研究计划,计划,老年收缩期高血压,美卡素,+HCTZ vs,氨氯地平,+HCTZ,糖尿病肥胖,美卡素,+HCTZ vs,缬沙坦,+HCTZ,血压晨峰,美卡素,+HCTZ vs,氯沙坦,+HCTZ,肾脏内皮功能障碍,美卡素,vs,雷米普利,糖尿病肾病,美卡素,vs,缬沙坦,糖尿病肾病,美卡素,vs,氯沙坦,糖尿病肾病,美卡素,vs,安慰剂,糖尿病肾病,美卡素,vs,依那普利,美卡素与氯沙坦比较：,最后6小时,Smith et al.,Blood Press Monit,2003;8:111117,*,*,*,P0.01，,与氯沙坦相比,氯沙坦 50100,mg,美卡素 4080,mg,2项剂量效应研究汇总分析,替米沙坦与缬沙坦比较,_ MICADO II,White WB et al,AM J Hypertens,2004:17(4):347-53,-6,-8,-10,-12,-14,-16,0,2,4,6,8,10,12,14,16,18,20,22,24,Time Post Dosing(Hours),SBP Reduction from Baseline(mmHg),Telmisartan,80 mg,Valsartan,160 mg,P0.02,Early AM,2,项双盲、交叉研究的汇总分析（,MICADO,I&,II,，,n=877,）,2,项独立研究的汇总分析（,MICADO,I&,II,）,2,4,10,14,12,6,8,16,18,20,22,24,漏服时间(小时,),美卡素与缬沙坦：漏服药物,Lacourcire,et al.,Blood Press Monit,2004:9;203210,P0.05,P0.005,P0.0001,P0.001,P,值为美卡素与缬沙坦相比,治疗4周后的1天患者接受双盲活性药物,或安慰剂（漏服）治疗,主要终点：,给药末,6,小时,的血压降低,Will