高血压心血管事件的临床研究.ppt
Percent hypertensive18-29Based on NHANES III (phase 1 and 2)Hypertension defined as blood pressure 140/90 mmHg or treatment30-3940-4950-5960-6970-7980+Age3 %9 %18 %38 %51 %66 %72 %JNC-VI. Arch Intern Med. 1997;157:2413-2446.Risk of hypertension (%)Residual lifetime risk of developing hypertension among people with blood pressure 140/90 mmHgYearsMenWomenVasan RS, et al. JAMA. 2002; 287:1003-1010.Copyright 2002, American Medical Association.050100150200250158-167148-157138-147128-13798-12798-10293-9788-9283-8768-82Society of Actuaries. Blood Pressure Study, 1939.Ratio (%) of actual to expected mortalitySystolic blood pressure (mmHg)Diastolic blood pressure (mmHg)Age-adjusted annualincidence of CHD per 1000Based on 30 year follow-up of Framingham Heart Study subjects free of coronary heart disease (CHD) at baselineSystolic blood pressure (mmHg)Diastolic blood pressure (mmHg)Framingham Heart Study, 30-year Follow-up. NHLBI, 1987.01234Relative risk of CHD mortality He J, et at. Am Heart J. 1999;138:211-219.Copyright 1999, Mosby Inc.11215198(lowest 10%)(highest 10%)SBP (mmHg)DBP (mmHg)Systolic blood pressure (SBP)Diastolic blood pressure (DBP)CHD=coronary heart disease0123456789Relative risk of stroke death 11215198(lowest 10%)(highest 10%)SBP (mmHg)DBP (mmHg)Systolic blood pressure (SBP)Diastolic blood pressure (DBP)He J, et at. Am Heart J. 1999;138:211-219.Copyright 1999, Mosby Inc.020406080100Age-adjusted annual CVD event rate per 1000Wilking SV et al. JAMA. 1988;260:3451-3455.MenWomenISH BP 160/95 mmHgBP 140/95 mmHg8243332.4182.5CVD=cardiovascular disease ISH=isolated systolic hypertensionP0.001 for difference between both men and women with ISH and blood pressure (BP) 140/95 mmHgIncidence of cardiovascular disease120140160180200220Treatment EffectSystolic blood pressure (mmHg)1967 VA Cooperative Study on DBP 115-1291970 VA Cooperative Study on DBP 90-1141979 HDFP1980 Australian Trial, Oslo Trial1985 MRC I, EWPHE1991 SHEP, STOP-Hypertension 1992 MRC II in the elderly1997 Syst-Eur 2002 LIFE2002 ALLHATVeterans Administration, 1967Veterans Administration, 1970Hypertension Stroke Study, 1974USPHS Study, 1977EWPHE Study, 1985Coope and Warrender, 1986SHEP Study, 1991STOP-Hypertension Study, 1991MRC Study, 1992Syst-Eur Study, 1997TotalOdds ratios and95% confidence intervals00.511.520.79(0.69 to 0.90)He J, et al. Am Heart J. 1999; 138:211-219.Copyright 1999, Mosby, Inc.Active treatment better than placeboActive treatment worse than placeboVeterans Administration, 1967Veterans Administration, 1970Hypertension Stroke Study, 1974USPHS Study, 1977EWPHE Study, 1985Coope and Warrender, 1986SHEP Study, 1991STOP-Hypertension Study, 1991MRC Study, 1992Syst-Eur Study, 1997Total00.511.520.63(0.55 to 0.72)Odds ratios and95% confidence intervalsActive treatment better than placeboActive treatment worse than placeboHe J, et al. Am Heart J. 1999; 138:211-219.Copyright 1999, Mosby, Inc.Cohort143 menMean age51 yearsEligibilityDiastolic BP 115-129 mmHgDesignDouble blind; placebo controlTherapyHCTZ, reserpine, hydralazineDuration1.5 yearsBP change-43/30 mmHgVA Cooperative Study Group. JAMA. 1967;202:1028-1034.HCTZ=hydrochlorothiazide -121201020304050Change in Systolic BP (mmHg)Percent of patientsPercent of patientsChange in Diastolic BP (mmHg)010203040500102030405001020304050-76 -60 -44 -28028Decrease (-)(+) IncreaseActive drugsPlaceboActive drugsPlaceboVA Cooperative Study Group. JAMA. 1967;202:1028-1034.Copyright 1967, American Medical Association.-1212-76 -60-44 -28028Decrease (-)(+) IncreasePlacebon=70Active Rx*n=73 Accelerated hypertension120Stroke41Coronary event20CHF20Renal damage20Deaths40VA Cooperative Study Group. JAMA. 1967;202:1028-1034.*P0.001 active drug therapy vs placebo The actively treated group experienced a reduction in multiple hypertension-related endpoints21 morbid/fatal events on placebo1 morbid/fatal event on active therapyVA Cooperative Study Group. JAMA. 1967;202:1028-1034.Cohort380 menMean age50 yearsEligibilityDiastolic BP 90-114 mmHgDesignDouble blind; placebo controlTherapyHCTZ, reserpine, hydralazineDuration5.5 years (mean=3.8 yrs)BP changeDiastolic BP -19 mmHgVA Cooperative Study Group. JAMA. 1970;213:1143-1152.Accelerated hypertension40Stroke205Total coronary event1311Fatal coronary event116Congestive heart failure110Renal damage30Deaths198VA Cooperative Study Group. JAMA. 1970;213:1143-1152.*P 60 yrs old; mean 72 yrs oldEligibilitySystolic BP 150 239 mmHg; diastolic BP 90 119 mmHgDesignDouble blind; placebo controlTherapyHCTZ, triamtereneDuration4.7 yearsBP change-21/10 mmHg at 5 yearsAmery A, et al. Lancet. 1985;1:1349-1354. 708090100Survival free of event (%)Year of follow-upActive (n=416)Placebo (n=424)P=0.02301362457Amery A, et al. Lancet. 1985;1:1349-1354.Reprinted with permission from Elsevier Science. EWPHE=European Working Party on High Blood Pressure in the Elderly Active treatment reduced cardiovascular (CV) mortality, largely due to a reduction in cardiac mortality Older patients (60 yrs ol
