单片复方制剂在原发性高血压治疗中的研究进展

原发性高血压是全球公共卫生问题,是导致心脑血管疾病发生和死亡的最主要的危险因素。高血压会显著增加脑卒中、心肌梗死、心力衰竭及慢性肾脏病等并发症的发生率和死亡率,严重危害人体健康。因此,预防和治疗高血压对减轻全球疾病负担,延长人类寿命有重要意义。目前,中国原发性高血压的患病率呈上升趋势,但血压控制率仍很低。随着医疗科技的发展,在降压方案选择方面,单片复方制剂治疗原发性高血压是一个热点话题。现通过整理近年来最新发表的研究,旨在进一步分析讨论单片复方制剂方对原发性高血压的疗效,并为临床医生在降压方案选择方面提供参考。     

单片复方制剂降压治疗中国专家共识

与单药治疗或传统的阶梯治疗、序贯治疗等方法相比,近年来出现的各种组方简单(通常使用两种指南推荐的降压药物)的单片复方制剂可更有效地控制血压。多个高血压指南均建议使用这些单片复方制剂。现阶段,一方面,我国高血压的控制率仍较低,另一方面,单片复方制剂在降压药中的使用比例却不高。因此,中华医学会心血管病学分会组织了有关单片复方制剂降压治疗的学术讨论,并制定本共识文件,系统分析使用单片复方制剂降压治疗的必要性和有效性,并提出明确的治疗建议。     

5种社区常用单片复方制剂降压药成本-效果分析

目的评价社区5287例高血压患者规范化管理中,5种常用单片复方制剂复方罗布麻片、复方降压片、复方地巴唑氢氯噻嗪、北京降压0号和复方利血平治疗1年的成本-效果。方法基于经济发展水平和地理位置,选择16个省250个社区卫生服务中心(站)和卫生院,利用基层高血压规范化管理方案对社区医务人员进行培训,由受培训的基层医务人员对高血压患者实施规范化管理1年。高血压患者的基线和随访资料采用统一设计的调查问卷收集。采用成本-效果分析法评价单片复方制剂治疗的经济效果。结果与其他3种复方制剂比较,复方罗布麻片(29.2元)和复方降压片(32.9元)的年人均成本较低;复方地巴唑氢氯噻嗪[(9.6±8.1)%,(8.6±8.0)%]和复方罗布麻片[(9.5±7.3)%,(8.5±8.8)%]的平均收缩压和舒张压下降率较大;复方地巴唑氢氯噻嗪(75.3%)和复方利血平(58.5%)的血压控制率较高。总体,复方罗布麻片和复方地巴唑氢氯噻嗪的成本-效果比较低。结论在社区单片复方制剂降压效果方面,复方罗布麻片和复方地巴唑氢氯噻嗪具有较好的成本-效果。     

充分发挥单片复方制剂在降压治疗中的优势作用

高血压是心血管系统最重要的危险因素之一,将血压持久地控制在目标值以下可以明显减少高血压所致的靶器官损害与不良心血管事件。药物治疗是降压达标的主要手段,合理的联合用药则是提高血压达标率、改善患者远期预后的核心策略。单片复方制剂     

海捷亚治疗老年原发性高血压的观察

目的观察海捷亚对老年高血压的治疗作用及对靶器官的影响。方法40例老年高血压患者口服海捷亚(氯沙坦50mg，氢氯噻嗪12.5mg)1片，每日一次，共8周，治疗前后测血压及行24h动态血压监测(ABPM)。结果治疗第1周有效率50％，第2周达67.5％，服药4周总有效率达73.3％；谷峰比(T/P)SBP78％、DBP77％；对75.8％患者异常的血压昼夜节律有逆转作用；不良反应轻微，对心率、血钾、尿酸影响较小。结论海捷亚能快速、平稳控制血压。     

厄贝沙坦氢氯噻嗪复方制剂治疗原发性高血压89例疗效观察

欧洲高血压学会指出,大多高血压患者需要联合应用至少2种降压药物才可使血压达标。而固定剂量复方制剂降压治疗,可简化治疗方案,提高患者顺应性。2008年2月～2010年6月,我们应用厄贝沙坦氢氯噻嗪复方制剂（依伦平）治疗高血压取得满意疗效。现报告如下。     

复方罗布麻片联合硝苯地平治疗原发性高血压77例疗效观察

目的观察复方罗布麻片联合硝苯地平对原发性高血压的疗效。方法选取150例原发性高血压患者,随机分为两组,对照组给予硝苯地平缓释片,治疗组在对照组基础上加用复方罗布麻片,疗程8周。结果两组疗效比较差异有统计学意义(P0.05)。治疗后两组患者收缩压和舒张压与治疗前比较,差异均有统计学意义(P0.05);治疗后两组患者收缩压和舒张压比较差异有统计学意义(P0.05)。结论复方罗布麻片具有稳定的降压效果,与硝苯地平合用疗效较好。     

苯磺酸氨氯地平片与氢氯噻嗪片治疗老年高血压临床对比观察

目的探讨苯磺酸氨氯地平片与氢氯噻嗪片用于老年高血压的降压疗效对比。方法选取110例Ⅱ、Ⅲ级老年高血压患者,随机分为氨氯地平组(55例)和氢氯噻嗪组(55例),氨氯地平组给予苯磺酸氨氯地平片10 mg,早上1次,厄贝沙坦片150 mg,早上1次;氢氯噻嗪组给予氢氯噻嗪片25 mg,早上1次,厄贝沙坦片150 mg,早上1次,观察纳入时和治疗14 d后,收缩压和舒张压的变化。结果治疗前,氨氯地平组和氢氯噻嗪组患者的收缩压和舒张压比较,差异均无统计学意义(P0.05);治疗后,两组患者的血压均比治疗前下降,差异有统计学意义(P0.05),氨氯地平组比氢氯噻嗪组下降更明显,差异有统计学意义(P0.05);两组的总有效率差异无统计学意义(P0.05),但秩和检验结果显示氨氯地平组患者临床疗效优于氢氯噻嗪组,差异有统计学意义(u=2.408,P=0.016)。结论苯磺酸氨氯地平片和氢氯噻嗪片均能降低Ⅱ、Ⅲ级老年高血压,但苯磺酸氨氯地平片比氢氯噻嗪片作用持续时间长,起效快,降压平稳,容易达标。     

新型单片联合制剂治疗老年高血压中国专家共识

良好的血压控制是减少心脑血管事件的基本途径,选择有效、安全和简便的降压治疗方案,实现平稳持久控制血压,对老年高血压患者具有重要意义。基于循证研究证据及老年高血压患者特殊的临床表现和病理生理特点,"新型单片联合制剂治疗老年高血压中国专家共识"建议新型自由联合或单片联合制剂(single-pill combination,SPC)是优化起始联合治疗的便捷方式,对提高老年高血压患者降压达标率,改善长期治疗的依从性和持续性、减少药物不良反应具有积极意义。     

Efficacy and safety of two single-pill fixed-dose combinations of angiotensin II receptor blockers/calcium channel blockers in hypertensive patients (EXAMINER study)

Background: There is some controversy regarding which single-pill fixed-dose combinations of angiotensin II type 1 receptor blockers (ARBs) and calcium channel blockers (CCBs) are effective at reducing blood pressure (BP). Methods: Sixty hypertensive patients who received a single-pill fixed-dose combination of valsartan 80?mg/day and amlodipine 5?mg/day were enrolled (UMIN Registration 000013460). They were randomly divided into two treatment groups [single-pill fixed-dose combination therapy with valsartan 80?mg/day and amlodipine 5?mg/day (Val/Am group), or irbesartan 100?mg/day and amlodipine 5?mg/day (Irb/Am group)] and treated for 16 weeks. If the patient did not reach the target office BP at 8 weeks, they received double doses of amlodipine (10?mg/day). Results: In the Irb/Am group, systolic BP (SBP) and diastolic BP (DBP) were significantly decreased at 16 weeks. There were no significant changes in SBP or DBP in the Val/Am group. In the Irb/Am group, serum uric acid (UA) was significantly decreased at 8 weeks and patients who had hyperuricemia showed significantly decreased serum UA at 16 weeks. In addition, the levels of triglycerides (TG) were significantly decreased at 16 weeks in the Irb/Am group. Conclusion: A single-pill fixed-dose combination therapy with irbesartan 100?mg/day and amlodipine 5?mg/day was superior to the combination of valsartan 80?mg/day and amlodipine 5?mg/day with respect to significant decreases in BP, serum UA and TG in patients with hypertension.     

Efficacy and safety of two treatment combinations of hypertension in very elderly patients

The study compared valsartan/amlodipine combination with irbesartan/hydrochlorothiazide (HCTZ) combination in very elderly hypertensives. After a 4-week placebo period, 94 hypertensives, aged 75-89 years were randomized to valsartan 160mg/amlodipine 5mg or irbesartan 300mg/HCTZ 12.5mg for 24 weeks according to a prospective, parallel group study. After 4 weeks amlodipine or HCTZ was doubled in non-responders. Patients were checked every 4 weeks. At each visit clinical sitting, lying and standing blood pressure (BP), systolic BP (SBP) and diastolic BP (DBP) were evaluated, and an electrocardiogram was performed. At the end of the placebo period and of the treatment period a non-invasive 24-h ambulatory BP monitoring (ABPM) was performed and electrolytes and uric acid were evaluated. Both combinations significantly reduced ambulatory BP. In the valsartan/amlodipine group the mean reduction (-29.9/-15.6 for 24h, -28.6/-14.5mmHg for day-time and -26.2/-17.4mmHg for night-time SBP/DBP) was similar to that of the irbesartan/HCTZ group (-29.6/-15.4 for 24h, -29.3/-14.9mmHg for day-time and -25.4/-16.9mmHg for night-time SBP/DBP). Both combinations significantly reduced clinical sitting and lying BP values with no difference between treatments. BP changes from lying to standing position were significantly greater in the irbesartan/HCTZ group (-17.2/-9.1mmHg) than in the valsartan/amlodipine group (-10.1/-1.9mmHg, p<0.05 for SBP and p<0.01 for DBP vs. irbesartan/HCTZ). Potassium significantly decreased and uric acid significantly increased (-0.4mmol/l, p<0.05 and +0.5mg/dl, p<0.05 vs. baseline, respectively) only in the irbesartan/HCTZ group. In conclusion, both combinations were similarly effective in reducing ambulatory and clinical BP in very elderly hypertensives. However, valsartan/amlodipine offered some advantages in terms of less pronounced BP orthostatic changes and absence of metabolic adverse effects.     

Diagnosis and treatment of hypertensive crises in the elderly patients

Hypertension is a common clinical problem in the elderly worldwide and physicians of all types are likely to encounter patients with hypertensive urgencies and emergencies in these patients. Although various terms have been applied to these conditions, they are all characterized by acute elevations in blood pressure and evidence of end-organ injury. Prompt, but carefully considered therapy is necessary to limit morbidity and mortality. A wide range of pharmacologic alternatives are available to the practitioner to control blood pressure and treat complications in these patients. The management of the elderly patient with hypertensive crises needs to include close monitoring and a gentle decline in blood pressure to avoid catastrophic complications, exacerbation of ischemic myopathy, and vascular insufficiency.     

两种术式治疗老年患者不稳定股骨转子间骨折的疗效比较

目的 探讨股骨近端防旋髓内钉（proximal femoral nail anti-rotation,PFNA）和人工股骨头置换术（femoral head replacement,FHR）治疗老年不稳定型股骨转子间骨折的临床疗效。方法 收集2017年1月—2020年10月在成都医学院第二附属医院接受治疗的120例老年不稳定股骨转子间骨折患者的临床资料,其中62例采用PFNA内固定术治疗（PFNA组）,58例采用FHR术治疗（FHR组）,比较2组的手术相关指标、炎性因子水平及并发症发生率,记录2组患者随访半年髋关节功能评定情况。结果 2组手术时间比较差异无统计学意义（P> 0.05）,与FHR组相比,PFNA组切口长度较短,术中出血量较少,但下床时间较晚（P<0.05）;术后1d,2组白细胞介素6 (interleukin-6,IL-6)、C-反应蛋白（C-reactive protein,CRP）、白细胞（WBC）计数水平比较差异无统计学意义（P> 0.05）,术后7d,2组IL-6、CRP、WBC水平均降低,且PFNA组低于FHR组（P<0.05）;FHR组...     

The role of ACE inhibitors in the treatment of hypertensive elderly patients

Hypertension has a high prevalence among elderly patients. Randomised trials have already demonstrated that treating healthy older persons with hypertension is highly efficacious. Nevertheless some questions have arisen. On the one hand the generalizability of these trial results, particularly for older persons with serious medical comorbidities and poor functional status, is not clear. On the other hand different antihypertensive drugs have shown to be effective. Which drug for which patient? Even data from randomised intervention trials showing that the treatment affects cardiovascular morbidity and mortality, were missing, ACE inhibitors have been used for more than a decade to treat high blood pressure. For a younger population the captopril prevention project showed no differences between ACE inhibitors and conventional antihypertensive treatment (diuretics, beta-blocker) concerning the primary endpoints (myocardial infarction, stroke and other cardiovascular death). The STOP-2 study also confirmed these results for elderly patients. When treating elderly patients one must be aware of physiological changes with age and the comorbidities. Of significance among this patient group is declining renal function. Admissions for uraemia that are related to the use of ACE inhibitors are still commonplace, although many cases are preventable by monitoring renal function, but guidelines are still missing. Concerning the comorbidities ACE inhibitors have benefits compared to other antihypertensive drugs, especially in cases of heart failure, diabetes and coronary heart disease.     

老年高血压合并衰弱患者降压治疗的研究进展

高血压是影响老年人健康的重要因素,降压治疗可降低老年高血压患者脑卒中、心血管事件和死亡等风险。老年人群中衰弱常与高血压并存,但目前关于老年高血压与衰弱的研究相对较少,尤其是老年高血压合并衰弱的降压治疗研究结论不一。老年高血压合并衰弱患者降压治疗的起始值与目标值、衰弱老年人能否从降压治疗中获益以及降压治疗方案的选择等仍争议较大。因此,本文对老年高血压患者合并衰弱的降压治疗进行综述。     

Captopril in the treatment of the elderly hypertensive patient

As part of a large multicenter surveillance study of captopril, 975 hypertensive patients aged 65 years or older were treated, 418 of whom received the drug for at least 12 months. Blood pressure was lowered from an entry level of 193/105 +/- 30/16 (mean +/- SD) to 159/88 +/- 25/12 mm Hg, and side effects were infrequent. During treatment, renal function was undisturbed in the majority of patients. The frequency of clinically evident hypotensive episodes did not differ from that found in the total study population, suggesting that in this age group, despite the reduction in blood pressure, cerebral perfusion was maintained. This experience suggests that captopril can be used for the treatment of the elderly hypertensive patient.