高血压与糖尿病PPT课件.ppt

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1、BenefitofACEInhibitorsinDiabetes:ImportantFindingsof5MajorClinicalTrialsUKPDS(1998)Tightbloodpressurecontrolwithcaptopriloratenololcomparedtolesstightcontrolloweredtheratesofstroke,anydiabetesendpoint,microvascularoutcomes,anddeathIntensivecomparedtoconventionalglucosecontrollow

2、eredriskofanydiabetes-relatedendpoint,microvascularendpointsandmyocardialinfarctionHOPE&MICRO-HOPESubstudy(2000)Ramiprilcomparedtoplaceboaddedtousualcarereducestheoccurrenceofdeath,myocardialinfarction,andstrokeinbothdiabeticsandnondiabeticsRamiprildecreasedprogressionofproteinur

3、iaindiabeticsABCD(1998)EnalaprilcomparedtonisoldipineprovidedcomparablebloodpressurecontrolandbetterprotectionagainstmyocardialinfarctionABCD,CAPPP,FACETandUKPDSmeta-analysis(2000)ACEIscomparedtootheragentssignificantlyreducedthefrequencyofacutemyocardialinfarction,cardiovascular

4、events,andall-causemortalityRelativeriskfortightcontrol(95%CI)PValueRelativeriskreduction(95%CI)AnyDM-relatedendpoint0.76(0.62–0.92)0.005DM-relateddeaths0.68(0.49–0.94)0.02All-causemortality0.82(0.63–1.08)0.17Myocardialinfarction0.79(0.59–1.07)0.13Stroke0.56(0.35–0.89)0.01Periph

5、eralvasculardisease0.51(0.19–1.37)0.17Microvascularcomplications0.63(0.44–0.89)0.009UKPDSImpactofTight*vsLessTight†BloodPressureControlonDiabetes-RelatedEndpoints0.1110FavorstightcontrolFavorslesstightcontrol*n=758(meanachievedbloodpressureof144/82mmHg)†n=390(meanachievedbloodp

6、ressureof154/87mmHg)AdaptedfromUKPDSGroup.BMJ.1998;317:703–713.ReprintedwithpermissionfromtheBMJPublishingGroup.UKPDSEventRatesforSelectEndpointsWithTightvsLessTightBloodPressureControlAnydiabetes-relatedendpointDiabetes-relateddeathStrokeMicrovascularcomplicationsEventsper1000pa

7、tientyrsP=0.005P=0.02P=0.01P=0.009Lesstight(n=390)meanachievedBP154/87mmHgTight(n=758)meanachievedBP144/82mmHgUKPDSGroup.BMJ.1998;317:703–713.UKPDSRelativeRiskReductionforTight*vsLessTight†BloodPressureControlEndpoint%RelativeriskreductionPvalueAnydiabetes-relatedendpointDiabete

8、s-relateddeaths320.0050.02HeartfailureSt