高血压和冠心病：治疗策略和指南PPT课件

7
Outcomes in Patients Without Diabetes at Baseline
Unadjusted Relative Risk with 95% CI
Outcome New-Onset Diabetes
CAS n = 8101 No. (%)
569 (7.03)
NCAS n = 8082 No. (%)
2020年10月2日
Systolic Diastolic
0
-5
-10
Байду номын сангаас
-10.0 -10.2
p = 0.26
-15
-20 -18.7 -19.0 p = 0.41
4
Overall BP Control at 24 Months
% Patients
--INVEST--
-- ALLHAT -- -- LIFE --
2020年10月2日
2
INVEST
• Design
– Prospective, randomized, open trial with blinded endpoint evaluation (PROBE) to assess outcomes (death, MI, stroke) in hypertensive CAD patients treated with either a calcium antagonist based (verapamil SR) or noncalcium antagonist based (atenolol) treatment strategy
100
RR = 0.98, 95% CI 0.90, 1.06
95
CI for equivalence 0.83, 1.20
Cumulative %
90
85
log rank p = 0.57
80
75 0
2020年10月2日
CAS
NCAS
6 12 18 24 30 36 42 48 54 60
Months
80 70 63 63 60 50
72 71
61 57 54
48 45
40
30
20
10
0
JNC VI
<140/<90 mmHg
BP Goal
2020年10月2日
CAS NCAS CAS NCAS CHLOR AML LIS LOS ATEN
5
Alive, Free of MI or Stroke
Primary Outcome
Hypertension and Coronary Artery Disease:Management
Strategies and Guidelines
C.Richard Conti M.D. MACC GWICC 2004 Beijing PRC
2020年10月2日
1
Morbidity and Mortality in Contemporary CAD Patients With Hypertension Treated With Either a
– Preliminary results 4/2/03; updated results 9/3/03
2020年10月2日
3
Mean Blood Pressure
150 Systolic
130
24 Months
(mmHg)
Change in BP (mmHg)
110
CAS
NCAS
90
Diastolic
665 (8.23)
Death or New-Onset Diabetes
• Hypothesis
– Treatment strategies are equivalent (CI 0.83,1.20)
• BP Goals
– According to JNC VI (< 130/<85 mmHg for pts with diabetes and renal dysfunction, <140/<90 mmHg for all others)
• Study Characteristics
– Conducted in 862 Sites in 14 Countries
– Recruitment from 9/97-12/00; 22,576 patients randomized (ITT)
– Follow-up completed end of 2/03
•Total follow-up 61,835 patient-yrs
•Mean follow-up 2.7 yrs/patient
•Annual event rate = 3.6%
6
Primary and Secondary Outcomes
Unadjusted Relative Risk with 95% CI
Outcome
CAS n = 11267 No. (%)
First Event
1119 (9.93)
Death
873 (7.75)
Nonfatal MI
151 (1.34)
Nonfatal Stroke 131 (1.16)
CV Death
431 (3.83)
CV Hospitalization 726 (6.44)
70
0 1.5 3 4.5 6 12 18 24 30 36
CAS (n) 11,267 8594 7738 7119 NCAS (n) 11,309 8676 7726 7148
8558 8639 8573 8694
7758 7842 5721 7710 7850 5834
3659 3679
Time (Months)
Verapamil/Trandolapril or BetaBlocker/Diuretic Strategy
C.Richard Conti MD, MACC, Division of Cardiovascular Medicine University of Florida College of Medicine Gainesville, Florida USA
NCAS n = 11309 No. (%)
1150 (10.17)
893 (7.90)
153 (1.35)
148 (1.31)
431 (3.81)
709 (6.27)
p value
0.57
0.72
0.95
0.33
0.94
0.59
0.80
1.0
1.2
CAS Better NCAS Better
2020年10月2日