降压治疗研究新动向 强化、优化和简化扩展降压治疗能获益的人群，当前主要聚焦在80岁以上高龄高血压患者和血压水平1604.805.408.401.701.20.702.224.811.60Reference1.2100806040200 5.5 mmol/L3.325.671.71 (1.48-1.98)0.0001SAE renal failure0.280.642.27 (1.40-3.67)0.0006Need for dialysis0.550.781.42 (0.98-2.06)0.066Death after renal dysfunction1.842.211.20 (0.97-1.48)0.087*local definitionONTARGET:Renal Dysfunction Dialysis 366:895-906. ASCOT-BPLA:终点事件发生率累计事件发生率（%）HR (95% CI): 0.80 (0.72, 0.90)(天)P = 0.0002ACEI / HCTZCCB / ACEI650526Kenneth Jamerson, et al. Late Breaker presentation at ACC 2008. ACCOMPLISH: 心血管复合终点20%ACCOMPLISH: 意义 对特定人群选择优化的降压治疗方案提供了循证证据。 ACEI / CCB联合特别有利于减少冠心病事件( 心肌梗死、不稳定性心绞痛、血运重建)。在优化的基础上，简化降压治疗模式,寻找强效、快捷、平稳和安全的联合治疗方案和途径。新动向(三)降压治疗模式的历史演进序贯治疗(sequential monotherapy)阶梯治疗(stepped-care)联合治疗(Combination)Choose betweenLow-dose 2-drug combinationLow-dose single agentNot at BP goalFull dose of single agentSwitch to different agent at low doseFull dose of 2-drug combinationAdd a third drug at low doseNot at BP goal23 drug combination at full doseFull doses of 23-drug combinationFull-dose single agentMarked BP elevation High/very high CV risk Lower BP targetMild BP elevation Low/moderate CV risk Conventional BP targetTask Force for ESHESC. J Hypertens 2007;25:110587Algorithm for Treatment of Hypertension(ESH/ESC) TALENT study STudy EvALuating the Efficacy of Nifedipine GITS - Telmisartan in Blood Pressure Controli) Nifedipine GITS 20 mg then add Telmisartanii) Telmisartan then add Nifedipine iii) Nifedipine / Telmisartan combinationPercentage of patients fully adherent to fixed-dose Combination therapy and coadministered 2-pill therapy1009080706050403020100 0369121518212427Months after start of therapy21%17%Percentage of patients fully adherentFixed-dose combinationCoadministration of 2 pillsSturkenboom M, et al. 15th ESH meeting, Milan, Italy, June 17-21, 2005