摘要
既往的实践证明,单纯降压治疗可以比较好地解决高血压导致的心力衰竭和脑卒中;单纯降压治疗可以减少部分冠心病事件,但往往获益不足。高血压患者往往比较复杂,常合并血脂异常、年龄增加、吸烟、肥胖、高血糖、心血管病早发家族史等其他危险因素,这些危险因素协同作用加剧动脉粥样硬化的发生、发展。ASCOT-LLA研究证实,在降压治疗基础上,对血脂不高当时认为不需要治疗的水平,低密度脂蛋白胆固醇<135 mg/dL(3.51 mmol/L)但合并多项危险因素的高血压人群,联合10 mg阿托伐他汀治疗可在单纯降压降低冠心病事件10%的基础上,使致死性冠状动脉粥样硬化性心脏病和非致死性心肌梗死风险再降低36%。
The benefits of antihypertensive therapy for the prevention of cardiovascular mortality and morbidity are well established.Meta analysis shows that antihypertensive therapy for the prevention of stroke and heart failure is 38% and 52% reduction,but only 16% for lowering coronary artery disease,which is much lower than 25%～48% reduction of epidemiology data antiparticipated,with the reduction of systolic blood pressure 10～12 mm Hg or diastolic blood pressure 5～6 mm Hg.Due to its multifactorial pathophysiology and its frequent association with other relevant risk factors and clinical conditions,treatment of hypertension requires an integrated approach,including lifestyle measures,antihypertensive drugs and other therapies.Yet,worldwide general practitioners continue to focus their attention on the management of a single risk factor,eg,blood pressure,rather than to global cardiovascular risk profile.Modern strategies of cardiovascular prevention in hypertensive patients should move from a single risk factor based approach toward a more comprehensive risk evaluation in the individual patient.The Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm（ASCOT-LLA） compared the effect of atorvastatin（10mg/d） with placebo in normolipidaemic hypertensive patients who had not experienced a coronary event but had at least three additional cardiovascular risk factors and were receiving concomitant blood pressure regulating therapy.The study was stopped early,after a median follow-up of 3.3 years,and convincingly demonstrated that low-density lipoprotein-lowering agents can decrease the risk of adverse ischemic events 36% in patients with hypertension.
出处
《心血管病学进展》
CAS
2011年第1期29-30,共2页
Advances in Cardiovascular Diseases
关键词
高血压
动脉粥样硬化
治疗
hypertension
atherosclerosis
treatment
