3种方案治疗不稳定型心绞痛的成本-效果分析

目的 :探讨3种方案治疗不稳定型心绞痛的经济效果。方法 :将88例不稳定型心绞痛患者分为3组 ,方案1 :给予硝酸异山梨酯、阿司匹林、硝苯地平、硝酸甘油 ;方案2 :在方案1的基础上加用丹参注射液 ;方案3 :在方案1的基础上加用葛根素注射液。运用药物经济学进行成本 -效果分析。结果 :方案2与方案3的有效率明显高于方案1(P<0 05) ,方案2与方案3相似 (P>0 05) ;成本 -效果比 ,方案1为15 98 ,方案2为18 02 ,方案3为33 40 ;增量成本 -效果比 ,与方案1比 ,方案2为24 66 ,方案3为83 90 ;与方案2比 ,方案3为643 60。结论 :方案2为最佳治疗方案。     

社区原发性高血压3种治疗方案的成本-效果分析

目的评价3种治疗方案治疗社区原发性高血压的药物经济学效果。方法调查安徽省铜陵县钟鸣中心卫生院2006年6月至2008年5月动态管理的高血压患者中入选病例92例。采用卡托普利(A组)、硝苯地平缓释剂(B组)、硝苯地平缓释剂+卡托普利(C组)3种治疗方案,运用药物经济学成本-效果分析的方法进行评价。结果3种治疗方案临床有效率分别为73.30%、77.42%、93.55%;成本-效果比(C/E)分别为0.09、0.56、0.53,相对于A组而言,B、C增长的成本-效果比(△C/△E)分别为8.83、2.13。结论硝苯地平缓释剂+卡托普利(C组)是治疗社区原发性高血压最佳治疗方案。药物经济学为临床制定合理的治疗方案提供了客观依据。     

三种不同联合方案治疗高血压临床效果对比

目的：探讨分析采用3种不同联合方案治疗高血压的临床效果。方法随机选取2012年4月～2013年5月接受入院治疗的高血压患者82例,采用美托洛尔＋依那普利、氨氯地平＋氢氯噻嗪以及硝苯地平缓释剂＋卡托普利联合的3种治疗方案,观察3种方案的治疗效果。结果A组美托洛尔＋依那普利的总有效率为90.7%,B组氨氯地平＋氢氯噻嗪总有效率为87.8%,C组硝苯地平缓释剂＋卡托普利总有效率为93.55%。结论采用硝苯地平缓释剂＋卡托普利联合方案治疗高血压疗效较佳。     

硝苯地平及氨氯地平和美托洛尔治疗老年原发性高血压的成本－效果分析

目的分析硝苯地平、苯磺酸氨氯地平和美托洛尔3种不同药物治疗老年原发性高血压的成本一效果。方法将180例老年原发性高血压患者完全随机分为硝苯地平组、苯磺酸氨氯地平组及美托洛尔组，每组60例。硝苯地平组予以硝苯地平治疗，1次／d，30mg／次；苯磺酸氨氯地平组予以氨氯地平治疗，5mg／次，1次／d；美托洛尔组予以美托洛尔治疗，50mg／次，2次／d。治疗8周后，比较3组患者临床疗效，计算成本并进行成本一效果分析。结果苯磺酸氨氯地平组有效率明显高于硝苯地平组、美托洛尔组[95．0％（57／60）比85．0％（51／60）、78．3％（47／60）]，差异有统计意义（P〈0．05）。硝苯地平组、苯磺酸氨氯地平组及美托洛尔组成本一效果比分别为3．57、2．32、1．54，增量成本．效果比硝苯地平组、苯磺酸氨氯地平组分别为18．22、5．94。结论3种药物中，氨氯地平是治疗老年原发性高血压经济有效的最佳选择。     

治疗心脑血管疾病的药物经济学研究

概述心脑血管疾病的药物经济学研究.运用成本 效果分析,结果表明,硝苯地平、比索洛尔、硝苯地平加卡托普利、硝苯地平加依拉普利为高血压病治疗的较好方案;前列地尔加硝酸异山梨酯是治疗冠心病心绞痛的较好方案;尿激酶是治疗急性心肌梗死的较好方案;蝮蛇抗栓酶是治疗脑梗死的较好方案.     

吲达帕胺与硝苯地平治疗中度高血压的费用—效果分析

目的：探讨吲达帕胺和硝苯地平治疗方案对高血压病产生的经济效果。方法：采用回顾性研究和费用－效果分析法,计算中度高血压患者的治疗成本,进行药物经济学评价。结果：吲达帕胺治疗中度高血压优于硝苯地平。结论：药物经济学可为临床合理用药,优选治疗方案提供一定的参考。     

三种钙通道阻滞剂治疗高血压的费用—效果分析

探讨3种钙通道阻滞剂治疗高血压的经济效果。方法 根据献选择152例高血压病人,随机分为3组,分别给予氯氯地平、非洛地平、缓释硝苯地平进行治疗,运用药物经济学的费用－效果分析方法进行评价。结果与结论 非洛地平是治疗高血压的最佳钙通道阻滞剂。药物经济学在临床药物治疗过程中拟定出合理的费用－效果处方,帮助医师、药师选择最佳治疗方案,以期用最小成本获得最大效益方面具有指导作用。     

3种方案治疗不稳定型心绞痛的成本-效果分析

目的探讨3种方案治疗不稳定型心绞痛的经济效果.方法将88例不稳定型心绞痛患者分为3组,方案1给予硝酸异山梨酯、阿司匹林、硝苯地平、硝酸甘油;方案2在方案1的基础上加用丹参注射液;方案3在方案1的基础上加用葛根素注射液.运用药物经济学进行成本-效果分析.结果方案2与方案3的有效率明显高于方案1(P＜0.05),方案2与方案3相似(P＞0.05);成本-效果比,方案1为15.98,方案2为18.02,方案3为33.40;增量成本-效果比,与方案1比,方案2为24.66,方案3为83.90;与方案2比,方案3为643.60.结论方案2为最佳治疗方案.     

3种常用降压药物的成本-效果比较

目的:探讨临床常用降压药物氢氯噻嗪、硝苯地平控释片、卡托普利治疗高血压的临床效果和经济效果。方法:门诊高血压患者随机给予氢氯噻嗪、硝苯地平控释片、卡托普利,运用药物经济学中的成本-效果分析法进行比较。结果:服药6周后各组患者血压值均有明显下降,临床降压效果最好者为硝苯地平控释片,费用效果比最佳者为氢氯噻嗪。结论:药物经济学为临床合理选药、合理利用医疗资源、为患者提供个体化治疗方案均有重要的指导意义。     

社区常用降压药物的经济学评价

目的探讨社区卫生服务中心常用降压药物北京降压0号片、美托洛尔、硝苯地平缓释片、卡托普利治疗高血压的临床效果和经济学效果。方法社区高血压患者随机给予北京降压0号片、美托洛尔、硝苯地平控释片、卡托普利,运用药物经济学中的成本-效果分析法进行比较。结果服药4周后各组患者血压值均有明显下降,临床降压效果最好者为硝苯地平控释片,费用效果比最佳者为卡托普利。结论药物经济学为社区卫生服务中心合理选药、合理利用医疗资源、为患者提供依从性治疗均有重要的指导意义。     

Effect of the lipase inhibitor orlistat on the pharmacokinetics of four different antihypertensive drugs in healthy volunteers

Objective: To study the influence of the lipase inhibitor orlistat on the pharmacokinetics of the antihypertensive drugs atenolol, furosemide, captopril and nifedipine. Methods: Four open-label, crossover studies were performed on six to eight healthy male volunteers. Orlistat was given in doses of 50 mg 3 times daily mid-meal for 7 (nifedipine and captopril) or 8 days (atenolol and furosemide). The four antihypertensive drugs (atenolol 100-mg tablet, furosemide 40-mg tablet, captopril 50-mg tablet and nifedipine 20-mg slow-release tablet) were administered in single doses twice, once before and once together, with orlistat at the end of the orlistat treatment period. Results: The plasma concentration time profiles and the pharmacokinetic parameters estimated for these drugs were in the expected range, except for furosemide, whose bioavailability was lower than reported in the literature. This was probably due to the fact that furosemide was given during a meal. There were minor, but statistically significant, differences in one of the pharmacokinetic parameters of furosemide and nifedipine (no difference for captopril and atenolol) when these drugs were given alone and in combination with orlistat: the half-life of furosemide was slightly longer, the time to peak plasma concentrations of nifedipine was slightly longer. None of these are considered to be clinically significant changes. Conclusions: The lipase inhibitor orlistat given 50 mg 3 times daily does not alter the pharmacokinetics of atenolol, furosemide, nifedipine and captopril to a clinically significant extent. Received: 15 November 1995/Accepted in revised form: 22 February 1996     

Functional arterial baroreflex attenuates the effects of antihypertensive drugs in conscious rats

The present work was designed to observe the influences of arterial baroreflex (ABR) function on cardiovascular effects produced by four routinely used antihypertensive drugs in conscious rats. A low ABR model was obtained by the performance of sinoaortic denervation (SAD). The doses of the four drugs were as follows: nifedipine (1.5, 3.0 mg/kg), captopril (50, 100 mg/kg), atenolol (10, 20 mg/kg), and hydrochlorothiazide (20, 40 mg/kg). They were administered via an intra-gastric catheter. Compared with sham-operated rats, SAD significantly increased blood pressure variability about 2 times without modification of blood pressure level. The decrease in blood pressure level induced by the four tested drugs was larger in SAD rats than in sham-operated rats, which decreased to about 10 mmHg. Pulse interval was not changed by the treatment of captopril, but prolonged by atenolol in both sham-operated and SAD rats. In sham-operated groups, treatment of both nifedipine and hydrochlorothiazide decreased pulse interval. Whereas in sinoaortic denervated ones, this tachycardia was prevented. Among the four tested drugs, it was found that only nifedipine and atenolol significantly decreased blood pressure variability in SAD rats. It can be concluded that arterial baroreflex function was able to attenuate the hypotensive effects produced by antihypertensive drugs in conscious rats.     

Exercise performance during captopril and atenolol treatment in hypertensive patients.

1. Maximal aerobic exercise capacity, submaximal endurance exercise performance, and exercise haemodynamics have been studied in sixteen patients with mild to moderate essential hypertension during treatment with captopril and atenolol. 2. Administration of atenolol (1 x 100 mg day-1) or captopril (1 x 100 mg day-1) for 6 weeks resulted in similar supine and erect systolic and diastolic blood pressures. Heart rate was significantly lower during atenolol treatment. 3. Exercise heart rate and systolic blood pressure were significantly lower during atenolol than during captopril treatment, exercise diastolic blood pressure (at 100W) did not differ significantly. With atenolol exercise cardiac output was significantly lower and exercise stroke volume significantly higher than with captopril. 4. Maximal work rate, maximal oxygen consumption and maximal heart rate were significantly lower during atenolol than during captopril treatment (respectively 6%, 8% and 25%). Maximal respiratory exchange ratio and lactate concentration did not differ. 5. No statistically significant difference in submaximal endurance time between atenolol and captopril was found. Endurance time was reduced by 19% during atenolol and by 13% during captopril as compared with placebo. No difference in rating of perceived exertion between atenolol and captopril was present. 6. The results indicate that atenolol will reduce blood pressure during exercise more effectively than captopril in patients with hypertension. The limitation of submaximal endurance exercise performance by both agents is of similar magnitude. This may be regarded as an unwanted side effect in certain physically active patients with hypertension.     

Quality of life evaluation of antihypertensive drugs

Eleven studies (10 randomised controlled trials and 1 large open study) that evaluated quality of life (QOL) are reviewed. The areas of QOL measured by the studies are compared and a consensus is reported that health-related QOL measures in patients with hypertension should include: symptomatic and psychological well-being, activity (work, leisure, sleep, sexual activity and social participation), cognitive function and life satisfaction. Recommended methods for measuring these aspects of QOL are noted. Seven studies included atenolol as 1 of the treatments and the effects of this drug on QOL are reviewed. The drug appears to maintain QOL as well as the angiotensin converting enzyme (ACE) inhibitors captopril, enalapril and cilazapril. One trial also suggests that verapamil maintains QOL as well as atenolol, although this was not suggested by the nonrandomised study. Nifedipine slow release (SR) and propranolol both fared worse than atenolol in 2 separate trials, but 1 trial suggested that nifedipine gastrointestinal therapeutic system (GITS) was preferred to atenolol in terms of QOL. In the latter study, however, only patients completing the prescribed therapy revealed a preference for nifedipine GITS; this was absent in an intention-to-treat analysis. The rate of discontinuation of nifedipine therapy was high, underlining the necessity for an intention-to-treat analysis in trials assessing QOL.     

Slow release nifedipine and atenolol as initial treatment in blacks with malignant hypertension.

We have compared the efficacy and safety of slow release nifedipine and atenolol given orally as initial treatment for malignant hypertension. Twenty consecutive black patients with untreated malignant hypertension, whose diastolic pressure remained greater than 120 mm Hg after 3 h bed rest, were randomized to receive either slow release nifedipine 40 mg at 1 and 12 h, or atenolol 100 mg at 0 h only. Patients remained supine throughout the study. Blood pressure was measured using a semi-automatic recorder (Omega 1000) at 15 min intervals from -3 to 24 h. Baseline blood pressure was similar in the nifedipine (233/142 mm Hg) and atenolol (226/141 mm Hg) groups. The rate of fall of pressure was greater after nifedipine whose maximum hypotensive effect occurred 4-5 h after each dose. Blood pressure decreased more slowly and more enduringly after atenolol, although the extent of fall was the same (delta BP 5 h after first dose nifedipine = 67/41 mm Hg; delta BP 16 h after atenolol = 64/40 mm Hg). There were no precipitous falls in pressure. No patient developed focal neurological signs, nor was heart failure precipitated by either form of treatment. These results support recommendations that most patients with malignant hypertension can be managed without recourse to parenteral therapy.     

HPLC法测定硝苯地平阿替洛尔缓释双层片中2组分含量

目的测定硝苯地平阿替洛尔缓释双层片中 2组分含量。方法采用ODS(Hypersil,5 μm,4 6mm× 2 0 0mm)为填充剂 ,甲醇 水 磷酸 ( 70∶30∶0 1 )流动相的高效液相色谱法。结果硝苯地平和阿替洛尔线性分别为 0 4 0～ 1 2 0 μg ,0 80～ 2 38μg;回收率分别为 99 8%(RSD =1 0 %) ,99 9%(RSD =0 5 %)。结论该方法为评价该制剂的质量提供了可靠的方法     

Comparison of sublingual captopril and sublingual nifedipine in hypertensive emergencies

Hypertensive crises require immediate therapy, usually by parenteral drug administration. Sublingual nifedipine has been shown to be highly effective. However, the blood pressure fall following nifedipine is frequently associated with side-effects. The use of sublingual captopril has recently been indicated in hypertensive crisis, assuming that by this route, there would be a faster absorption and thus a more rapid effect on blood pressure than with the oral route. To verify this hypothesis, we have compared the hypotensive effects of sublingual nifedipine and sublingual captopril in 52 patients with hypertensive emergencies: 25-mg captopril and 10-mg nifedipine were administered sublingually to 28 and 24 patients, respectively. Blood pressures and heart rates were continuously measured up to 240 min postdose. A significant (P less than 0.001) hypotensive effect of both sublingual captopril and nifedipine therapy occurred at 5 min and persisted for 240 min. Heart rates increased with nifedipine, but decreased with captopril. We observed no side-effects in the captopril group, but flushing, tachycardia and headache were observed in 6 patients in the nifedipine group. We conclude that sublingual captopril is effective in patients with hypertensive emergencies and that captopril may be an excellent alternative to sublingual nifedipine in the urgent treatment of hypertensive crisis.     

Changes in rat liver monooxygenase activities after administration of atenolol, nifedipine and diltiazem alone and in combination

The effects of the Ca2+ antagonists nifedipine (NF) and diltiazem (DL) and of the cardioselective beta 1-adrenergic blocking agent atenolol (AT) on the hexobarbital (HB) sleeping time and on the activity of some liver drug-metabolizing enzyme systems in male Wistar rats were studied. Two hours after single oral administration, atenolol (150 mg/kg) did not change hexobarbital sleeping time, while nifedipine (50 mg/kg) and diltiazem (30 mg/kg) prolonged it by 171.2 and 99.6%, respectively. Coadministration of atenolol with diltiazem or with nifedipine significantly prolonged hexobarbital sleep by 205 and 283%, respectively. Administered alone, atenolol decreased the ethylmorphine-N-demethylase (EMND) activity, but the amidopyrine-N-demethylase (APND) activity was not changed in any of the treated groups. Atenolol and nifedipine significantly increased aniline-4-hydroxylase (AH) activity and this effect was also observed with the combinations AT + NF and AT + DL. The NADPH cytochrome P-450 reductase activity was significantly decreased by nifedipine and diltiazem. Only nifedipine increased the total content of cytochrome P-450 (by 23.8%). Atenolol and diltiazem tended to increase the content of cytochrome b5 which was increased by nifedipine by 97.6%. The same effect was observed with the combinations AT + NF and AT + DL. The results suggest that NF, AT + NF and AT + DL produced the manifested changes in hepatic oxidative metabolism. The decreased EMND activity by atenolol, however, and the prolongation of hexobarbital sleeping time by nifedipine, diltiazem and their coadministration with atenolol did not correlate with enhanced microsomal P-450 and b5 content.     

硝苯地平联合卡托普利治疗原发性高血压的临床效果分析

目的观察研究硝苯地平联合卡托普利治疗原发性高血压的临床效果。方法将入住本院心血管内科并已确诊为原发性高血压的136例患者随机分为观察组68例和对照组68例。观察组患者进行使用硝苯地平控释片和卡托普利治疗,对照组患者服用卡托普利进行治疗。系统治疗8周后,评价两组患者的临床效果。结果观察组的总有效率为92．65％,对照组为75．00％,观察组的疗效明显优于对照组（P〈0．05）。观察组的舒张压和收缩压均明显低于对照组,两组差异有统计学的意义（P〈0．05）。结论硝苯地平联合卡托普利治疗原发性高血压的效果优于与单独服用卡托普利。     

Effects of nine antihypertensive drugs on blood pressure variability in sinoaortic-denervated rats

AIM: The present work was designed to investigate the effects of nine commonly used antihypertensive drugs on blood pressure (BP) and blood pressure variability (BPV) in conscious sinoaortic-denervated (SAD) rats. METHODS: Seventy-two SAD rats were randomly divided into nine groups. They were respectively given nifedipine 3 mg/kg, nitrendipine 5 mg/kg, amlodipine 1 mg/kg, clonidine 10 mug/kg, prazosin 0.5 mg/kg, atenolol 20 mg/kg, telmisartan 20 mg/kg, hydrochlorothiazide 40 mg/kg or captopril 50 mg/kg. The drugs were given via a catheter previously implanted into the stomach. BP was recorded for 5 h from 1 h before drug administration to 4 h after drug administration in conscious, freely moving rats. RESULTS: It was found that all these nine drugs significantly decreased BP in SAD rats. Six of these drugs (nifedipine, nitrendipine, amlodipine, clonidine, prazosin and atenolol) significantly decreased BPV in SAD rats, but the remaining three drugs did not. Clonidine and atenolol increased the heart period and the others did not. No drugs affected the heart period variability. CONCLUSION: Among nine antihypertensive drugs from different classes, calcium antagonists and sympathetic inhibitors decreased BPV in SAD rats.