基于临床试验高血压治疗策略.ppt
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(or more vs. less)
– When should drug treatment start? (BP level? Mild hypertension? Risk stratifications?)
– Whom should be treated? (Severe, mild, ISH)
Trials
Year Contributions
SHEP Systolic HT in the Elderly Reduced Total Stroke and all CHD VA study on Monotherapy CDN Captopril in Type 1 Diabetic Nephropathy
Syst.-China Chnese Systolic HT in the Elderly Trial
1991 Systolic HT in the elderly, ISH should be treated in older pts.
1990 1992
1992
HCHZ greatly enhanced the efficacy of non-diuretic drugs, HCTZ 12.5mg
STOP-HT The Swedish Trial in Old Pats. with HT
1987 1991
CHD could be reduced in POST-MI pts. by -blocker
Elderly HT pts. would benefit from anti HT treatment
Trials
Year
Contributions
VA Trial The VA Cooperative Study on Antihypertension Drugs HDFP The HT Detection and Followup Program(Australia)
ANBPS Australian National BP Study
Trials
Year Contributions
BHAT
- blocker Heart Attack Trial
1981
EWPHE
The European working Party on High BP in the Elderly
1984
MRC ELDERLY TRIAL Medical Research Council Trial of Treatment of HT in Older Adults
Hypertension Treatment Strategy Based on Clinical Trials
Liu Lisheng
• Is antihypertensive treatment beneficial? Trials of active treatment vs. placebo
HOT
1997
HT Optimal Treatment Trial
Combined lifestyle/drug intervention in stage I HT is beneficial
BP reduction in post stroke pts. is beneficial, even in normotensive
• Captopril can reduce progression of renal disease
• improved survival • Doubling of Serum Cr. Endpoint
Total mortality, CVD mortality & Stroke mortality reduced by CCB based treatment
Trials
Year
Contributions
TOMHS StuБайду номын сангаасy
The Treatment of Mild HT Study
PATs
Post Stroke Anti HT Treatment Study
Syst.-Eur.
Syst.-Eur. Multicentre Trial
1993 1993 1997
MRC trial The MRC Trial of Treatment in Mild HT(British)
1967 1976 1979 1977
Severe HT should be treated
• Large-scale CT could be conducted well & successfully in community • A 4-month observation period is advisable before instituting drug treatment • Absolute benefits were small in mild HT, treat 850 pts save 1 stroke • Mild HT, a weak claim for status as an entity
– To what extent?
• Is BP lowering by different antihypertensive agents equally beneficial?
• Necessity of Conducting Large-scale Clinical Studies using Asian Subjects
demonstrated a significant reduction in stroke, cardiac and all CVD events
Drug treatment in HT pts. 70-84 reduce CVD morbidity & mortality & total mortality
• New antihypertensive drugs • Prognosis of ISH, DM & dementia • ABP is a significant predictor of
outcome • BP to goal is possible • Comb. therapy was necessary in 70%
– When should drug treatment start? (BP level? Mild hypertension? Risk stratifications?)
– Whom should be treated? (Severe, mild, ISH)
Trials
Year Contributions
SHEP Systolic HT in the Elderly Reduced Total Stroke and all CHD VA study on Monotherapy CDN Captopril in Type 1 Diabetic Nephropathy
Syst.-China Chnese Systolic HT in the Elderly Trial
1991 Systolic HT in the elderly, ISH should be treated in older pts.
1990 1992
1992
HCHZ greatly enhanced the efficacy of non-diuretic drugs, HCTZ 12.5mg
STOP-HT The Swedish Trial in Old Pats. with HT
1987 1991
CHD could be reduced in POST-MI pts. by -blocker
Elderly HT pts. would benefit from anti HT treatment
Trials
Year
Contributions
VA Trial The VA Cooperative Study on Antihypertension Drugs HDFP The HT Detection and Followup Program(Australia)
ANBPS Australian National BP Study
Trials
Year Contributions
BHAT
- blocker Heart Attack Trial
1981
EWPHE
The European working Party on High BP in the Elderly
1984
MRC ELDERLY TRIAL Medical Research Council Trial of Treatment of HT in Older Adults
Hypertension Treatment Strategy Based on Clinical Trials
Liu Lisheng
• Is antihypertensive treatment beneficial? Trials of active treatment vs. placebo
HOT
1997
HT Optimal Treatment Trial
Combined lifestyle/drug intervention in stage I HT is beneficial
BP reduction in post stroke pts. is beneficial, even in normotensive
• Captopril can reduce progression of renal disease
• improved survival • Doubling of Serum Cr. Endpoint
Total mortality, CVD mortality & Stroke mortality reduced by CCB based treatment
Trials
Year
Contributions
TOMHS StuБайду номын сангаасy
The Treatment of Mild HT Study
PATs
Post Stroke Anti HT Treatment Study
Syst.-Eur.
Syst.-Eur. Multicentre Trial
1993 1993 1997
MRC trial The MRC Trial of Treatment in Mild HT(British)
1967 1976 1979 1977
Severe HT should be treated
• Large-scale CT could be conducted well & successfully in community • A 4-month observation period is advisable before instituting drug treatment • Absolute benefits were small in mild HT, treat 850 pts save 1 stroke • Mild HT, a weak claim for status as an entity
– To what extent?
• Is BP lowering by different antihypertensive agents equally beneficial?
• Necessity of Conducting Large-scale Clinical Studies using Asian Subjects
demonstrated a significant reduction in stroke, cardiac and all CVD events
Drug treatment in HT pts. 70-84 reduce CVD morbidity & mortality & total mortality
• New antihypertensive drugs • Prognosis of ISH, DM & dementia • ABP is a significant predictor of
outcome • BP to goal is possible • Comb. therapy was necessary in 70%