【文章內(nèi)容簡介】 fective than a diuretic/ACE inhibitor bination in lowering blood pressure, but also reduces the relative risk of cardiovascular events by 20%. These are the conclusions of the ACCOMPLISH study, presented yesterday at the American College of Cardiology Annual Scientific Meeting in Chicago. 69 70 ―ACCOMPLISH‖的評價(jià) ―Certain binations might have benefits that go beyond BP control, and that will be evaluated in ACCOMPLISH.‖ —Dr Bj246。rn Dahl246。f (ASCOTBPLA研究主持人 ) 71 最新的 FDCs是什么藥 ? 72 73 藥物降壓腦卒中獲益 冠心病獲益 74 75 高血圧 /高膽固醇與 CHD和卒中風(fēng)險(xiǎn)的關(guān)系 Lancet 2022。 365:434~441 76 77 78 (BPLA與 LLA兩部分 ) 79 80 氨氯地平 /左旋氨氯地平抗動脈粥樣硬化的機(jī)制 81 固定復(fù)方新制劑 ━ 降壓藥 +調(diào)脂藥應(yīng)運(yùn)而生 氨氯地平 +阿托伐他汀 商品名 :多達(dá)一 .Caduet。 由 Norvasc174。 (amlodipine besylate) and Lipitor174。 (atorvastatin calcium)組成 :于 2022年 1月 31日 在美國上市 ! 82 多達(dá)一 “ Caduet‖ (CAPSULES CANNOT BE CUT) 83 為適用于不同患者 —―Caduet‖的多種規(guī)格 CADUET: Following oral administration of CADUET peak plasma concentrations of amlodipine and atorvastatin are seen at 6 to 12 hours and 1 to 2 hours post dosing, respectively. The rate and extent of absorption (bioavailability) of amlodipine and atorvastatin from CADUET are not significantly different from the bioavailability of amlodipine and atorvastatin administered separately。 84 AML+ATO的臨床研究 Drugs 2022。 68 (7): 885900 85 AML+ATO的藥動學(xué)參數(shù) 及食物的影響 Drugs 2022。 68 (7): 885900 86 CCBs與沙坦類并用 87 CCB與 纈沙坦類聯(lián)用 ━ 倍博特 (Exfe) 分別含 5/10//80/160/320毫克 88 CCB+ARB協(xié)同拮抗血壓調(diào)節(jié)機(jī)制 89 CCB/ARB優(yōu)于 CCB/BB 90 不同劑量氨氯地平 /纈沙坦組合的療效比較 Renin Angiotensin Aldosterone Syst 2022。 9。 1~9 91 倍博特對伴有高危因素的高血壓患者也有效 92 倍博特 5mg/80mg對輕中度 國人高血壓患者的達(dá)標(biāo)率 93 Blood pressure changes before stroke Studies examine effects of variation in blood pressure on cardiovascular and stroke risk Five papers published in the Lancet and Lancet Neurology focus on the variability in blood pressure (BP) and the effects on cardiovascular and stroke risk. Readers with a more in depth interest in the management of hypertension are advised to view the plete papers (subscription required) for more detailed information. 94 Variation in blood pressure is an independent risk factor for stroke, but does it affect drug choice in hypertension? 1， Recent studies suggest that variation in blood pressure is also an independent risk factor for stroke 。 2， Some evidence suggests that diuretics and calcium channel blockers may offer advantages over ACE inhibitors/A2RAs and betablockers in treating those with variable blood pressure. 3， The NICE guideline remendation that diuretics or calcium channel blockers should be used firstline for most people (those over the age of 55 or black) with unplicated hypertension remains appropriate. Lancet 2022； 375； 895 905, 13 March 95 血壓變異性 ━ 更強(qiáng)效的卒中風(fēng)險(xiǎn)預(yù)測因子 近年來，大規(guī)模臨床試驗(yàn)顯示 血壓變異性 (Blood Pressure Variability。BPV)與腦卒中的發(fā)生密切關(guān)聯(lián)，已成為當(dāng)今防治高血壓的新靶點(diǎn)或新熱點(diǎn) ! ? 什么是血壓變異性 ?是指 一定時(shí)間內(nèi)血壓波動的程度 ,其檢測指標(biāo)仍在探索之中 !通常以不同時(shí)間 多次血壓連續(xù)讀數(shù)的標(biāo)準(zhǔn)差 (SD),變異系數(shù) (CV),兩個相鄰血壓讀數(shù)絕對差的平均值 (ASV)等來表示 。 ? 根據(jù)觀察周期的長短 ,血壓變異又分為 短時(shí)血壓變異和長時(shí)血壓變異 ,前者指 24h內(nèi)的 BPV。后者是指數(shù)天或數(shù)周甚至數(shù)月、數(shù)年內(nèi)的 BPV。 96 ASCOT研究的最新分析結(jié)果表明 血壓波動 對事件的預(yù)測力優(yōu)于治療后的平均血壓 New ASCOT Analysis Indicates BP Variability Predicts Events Better Than Mean Treatment BP ? ASCOT 試驗(yàn)的最新分析結(jié)果顯示，接受高血壓治療的患者相鄰兩次就診間的診室血壓波動對卒中和冠狀動脈事件的預(yù)測力遠(yuǎn)遠(yuǎn)優(yōu)于平均血壓，這不同于以往的觀點(diǎn)。 ? 這項(xiàng)大規(guī)模研究在 對心血管轉(zhuǎn)歸確實(shí)毫無影響，僅對卒中風(fēng)險(xiǎn)有極小的影響 。 ? 專家指出一個關(guān)鍵信息是， 假如你在接受治療，就結(jié)局而言，血壓較高而波動較小者遠(yuǎn)勝于血壓較低而波動較大者，此狀況令人堪憂。” 97 BP Variation Predicts Stroke Better than Mean Values ━ 藥物防治腦卒中必須關(guān)注血壓變異性 大量循證表明，不論何種降壓藥都應(yīng)增加對治療期間血壓控制 穩(wěn)定性 的重視，在 ASCOTBPLA研究的兩個治療組中 ,若隨診期間 SBP變異性很高 ,即使對研究藥物依從性較高且平均血壓控制良好的患者 ,其血管事件風(fēng)險(xiǎn)也會增加 5倍 。現(xiàn)有結(jié)果提示 ,長效鈣道阻滯劑如氨 氯地平 /左旋氨氯地平對于患者長期血壓變異性的良好控制是其更有效減少腦卒中的重要原因 。 98 99 100 101 102 103 104 Eff ects of antihypertensivedrug class on interindividual variation in blood pressure and risk of stroke: a systematic review and metaanalysis Alastair J S Webb, Urs Fischer, Ziyah Mehta, Peter M Rothwell Lancet 2022。 375: 906–15 105 Effects of antihypertensivedrug class on interindividual variation in blood pressure and risk of stroke: a systematic review and metaanalysis Mean (SD) SBP at followup was reported in 389 (28%) of 1372 eligible trials. There was substantial heterogeneity between trials in VR (p1 10?40), 68% of which was attributable to allocated drug class. Compared with other drugs, interindividual variation in SBP was reduced by calciumchannel blockers (VR 081, 95% CI 076–086, p00001) and nonloop diuretic drugs (087, 079–096, p=0007), and increased by angiotensinconverting enzyme (ACE) inhibitors (108, 102–115, p=0008), angiotensinreceptor blockers (116, 107–125, p=00002), and β blockers (117, 107–128, p=00007). Compared with placebo only, interindividual variation in SBP was reduced the most by calciumchannel blockers (076, 067–085, p00001). Effects were consistent in parallel group and crossover design trials, and in analyses of doseresponse. Across all trials, effe