Core tip: the recent results of the Anglo Scandinavian cardiac endpoint study (Ascot) are encouraging. The results strongly prove that the combination of new antihypertensive drugs is superior to traditional antihypertensive drugs, which provides a basis for the drug selection of antihypertensive treatment. At the same time, it also proves that the combination of atorvastatin and lipid-lowering therapy for patients with hypertension based on active control of blood pressure can make progress The risk of myocardial infarction and cerebral apoplexy was significantly reduced.
A few days ago, Professor Hu Dayi, a famous cardiovascular expert, and chairman of the evidence-based medicine professional committee of the Chinese Medical Association pointed out in an exclusive interview with people's Daily that the current new strategy for the treatment of hypertension should be to reduce blood pressure and lipid on one hand.
Professor Hu said that the recent results of the Anglo Scandinavian cardiac endpoint study (Ascot) were encouraging. The results strongly proved that the combination of new antihypertensive drugs was superior to traditional antihypertensive drugs, which provided a basis for the drug selection of antihypertensive treatment. At the same time, it proved that the combination of atorvastatin and lipid-lowering therapy for patients with hypertension based on active control of blood pressure could improve the blood pressure It can significantly reduce the risk of myocardial infarction and stroke. The main researchers of Ascot pointed out that we should pay attention to the assessment of the overall risk of patients, rather than considering the baseline TC level alone. If patients have hypertension and other three risk factors, even if the blood lipids are normal or slightly elevated, lipid-lowering therapy may still obtain significant clinical benefits.
1. Patients with hypertension should reduce blood pressure and lipid at the same time.
In the past, it has not been clear whether patients with high blood pressure need to reduce blood fat. We think that is to reduce blood pressure, no matter with the oldest drugs, diuretics, or the latest drugs, as long as the blood pressure is reduced. However, the results showed that only hypotension reduced myocardial infarction by 6%. Why didn't myocardial infarction come down?
Ascot findings were discussed at this year's annual meeting of the American College of Cardiology, the annual meeting of the European Heart Association, and the annual meeting of the American Heart Association. Before that, we really didn't know whether hypertensive patients should lower blood lipid and whether statins can cause cerebral hemorrhage in hypertensive patients. In the past, it was a great puzzle. Now, the results of this experiment show that the reduction of blood pressure in hypertensive patients on stroke is very obvious, but the reduction of myocardial infarction is limited. Hypertensive patients should lower blood pressure on the one hand and lower the dosage of statins on the other It doesn't need to be too big to further reduce stroke. At the same time, myocardial infarction is really reduced by a large margin. "Shortly, I believe the guidelines will be rewritten at home and abroad, emphasizing that patients with high blood pressure may benefit from statins," he said
2. The treatment of hypertension should first emphasize lowering blood pressure.
As for the treatment of hypertension, there were almost no antihypertensive drugs in the 1950s. Later, there was India's promo, and finally, reserpine was synthesized; in the 1960s, there was Cindy, and then there was eugenin (a drug that caused many side effects, which is not used now). But in any case, the blood pressure dropped, hypertension emergencies significantly reduced, cerebral hemorrhage significantly reduced, there is indeed a success. However, there are two core problems in the process of lowering blood pressure. One is that although stroke has decreased by 40%, it is not very satisfactory. How can it continue to decrease? The second is that myocardial infarction has only decreased by 16%, which is half of the expected rate. It has not come down for so many years.
In the 1980s, when evidence-based medicine began to be introduced, people put their hopes on new antihypertensive drugs, namely ARB vascular antagonists and α blockers. In the past, drugs for lowering blood pressure were not good for blood lipids and blood glucose, which made myocardial infarction unable to come down. So up to now, a large number of experiments have been carried out. Compared with the old drugs, almost none of the new drugs surpassed the old drugs. But we look at the different combinations of drugs, the final result can be that the new antihypertensive drugs in reducing stroke are significantly better than conventional drugs. But whether you use new or old antihypertensive drugs to reduce stroke and myocardial infarction, the most dominant role is to lower blood pressure. Even when the peripheral blood pressure is very close, this is the immediate blood pressure, especially the decrease of central aortic pressure, which is likely to be different. Therefore, I think that reaching the standard of lowering blood pressure is still mainline for the treatment of hypertension. As a researcher, we emphasize that the new antihypertensive drugs have other unexpected effects, and we can do a lot of experiments. But for the common people, the most important thing is reaching the standard of lowering blood pressure, which can reduce myocardial infarction and stroke
Professor Hu said: "at present, the most discussed in the academic circles and the most mentioned by experts are: we admit that new drugs are good, but you have to do so. How many people in China can afford this drug for these patients? I admit that lover and Yoshida are very expensive, but we can use new antihypertensive drugs to reduce stroke and myocardial infarction, which can break through the past Limit. Second, at least limited resources should be used for effective drugs, not for drugs without definite evidence of efficacy. The third is different types of classification. The rich have drugs for the rich, and the poor have consumption for the poor. It can not be said that taking cheap antihypertensive drugs has no effect. Many people die young mainly because of ignorance, not because they have no money to consume these things. "
