从《中国高血压综合防治研究》的早期结果看低剂量联合降压治疗方案的优势

我国现有2亿高血压患者,每10个成人中有2个是高血压。高血压的人群知晓率、治疗率和控制率很低,2002年调查结果仅分别为30%、25%和6%。由于以高血压为代表的危险因素未得到有效     

顽固性高血压治疗新药-内皮素受体拮抗剂

2006年美国心脏病学会上Weber教授报告口服选择性内皮素A型受体拮抗剂辅助治疗顽固性高血压的临床Ⅱ期报告。该研究收治115名病人，用3种足够剂量降压药65名，用4种降压药50例。降压药包括血管紧张素转换酶抑制剂（ACEI）、利尿剂、血管紧张素受体拮抗剂（ARB）以及其他种类降压药。研究是在多中心进行双盲法，采用的内皮素A型受体拮抗剂（darusentan）治疗组与安慰剂组人数比为2：1。治疗组药量从10mg／d开始，     

心力衰竭的病理生理机制及治疗概述

心力衰竭(Heart Failure，HF)指由于心脏泵血功能降低，虽有适量静脉回流，但排出的血量(心排出量)不足，以致动脉系统灌注不足(组织血液减少不能满足其代谢需要)和体(肺)静脉淤血(充血)的一组病理生理状态。HF与心功能不全(Cardiac in—sufficiency)在临床上常通用，没有本质区别。但心功能不全常指心功能受损后从代偿到失代偿的整个阶段，而HF常指心功能不全的失代偿阶段，临床上又称充血性心力衰竭(Congestive H．F，CHF)。患者主要出现疲劳(乏力)、气急(呼吸困难)、颈静脉怒张和周围性水肿(踝部肿胀)等症状。HF是临床上极为常见的危重病症，是心血管疾病患者丧失劳动力及死亡的重要原因之一。HF患者的死亡率是同龄普通人群的4—8倍^[4]。     

缬沙坦治疗高血压病对肾功能的影响

目的应用新一代降压药物血管紧张素受体拮抗剂(ARB)缬沙坦治疗轻、中度原发性高血压,观察降压效果及治疗前后肾功能的变化。方法选择轻、中度高血压病人停服原用药1周再服用安慰剂1周后,随机分为2组。缬沙坦组服用缬沙坦80～160mg/d;苯那普利组服用苯那普利10～20mg/d。入选病例65例,完成8周观察者共61例,缬沙坦组32例,苯那普利组29例。监测血压每周一次,并记录出现的不良反应。用药前后测血尿素氮、血肌酐、血尿酸、尿β2-MG、24h尿微量ALB。结果治疗8周后两组血压均下降,缬沙坦组下降(16.5±7.5/10.2±6.8)mmHg,总有效率为59.4%;苯那普利组下降(16.4±9.6/11.2±7.4)mmHg,总有效率62.1%,两组之间无显著的统计学差异。两组尿β2-MG、24小时尿微量ALB在治疗后均下降,亦无显著差异。结论缬沙坦有明显降压作用,副作用少,可降低尿中ALB及尿β2-MG,减轻肾脏病变。     

血管紧张素转换酶抑制剂治疗高血压

血管紧张素转换酶抑制剂是抗高血压药,其降压作用与抑制组织中存在的血管紧张素转换酶有关。它在身体不同部位可产生不同的血流动力学效果,如可增加原发性高血压病人的肾血流量和肾小球滤过率,增加正常人骨骼肌和皮肤的外周阻力等。有关该类药的药代动力学及对高血压的治疗文中亦做了介绍。 (吴晶摘)     

ACEI、ARB及醛固酮受体拮抗剂在心力衰竭患者中的应用

采用血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)或醛固酮受体拮抗剂,阻断或削弱肾素-血管紧张素-醛固酮系统的活性,是治疗慢性心力衰竭的主要策略之一。经过10多年的临床试验和实践,这3类药物的适应证和应用要点都已基本明确。ACEI是治疗慢性收缩性心力衰竭的基石和首选药物,ARB主要适用于不能耐受ACEI的患者。醛固酮受体拮抗剂的适应证为严重心力衰竭患者和心肌梗死后心力衰竭,使用时必须密切监测血钾和肌酐水平。     

高血压的治疗

降高血压药物分几类?当前用于降压的药物主要分为以下六类。即利尿药、β-受体阻滞剂、血管紧张素转换酶抑制剂(ACE-Ⅰ)、血管紧张素Ⅱ受体拮抗剂、钙拈抗剂和α-受体阻滞剂。     

降压药物与癌症风险

心血管病和癌症是全球范围内导致死亡的两大原因。据统计,约37%的癌症患者存在高血压[1-2],通过用降压药积极有效地控制血压可预防癌症患者心血管病的发生和提高他们的生活质量。目前,广泛应用的降压药包括血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)、血管紧张素受体拮抗剂(angiotensin receptor blocker,ARB)、β受体阻滞剂(beta-blocker,BB)、钙拮抗剂和利尿剂。     

赖诺普利与卡托普利降压疗效比较

赖诺普利 (商品名 :帝益洛 )是一种新型长效血管紧张素转换酶抑制剂 ( ACEI) ,与其他 ACEI相比具有许多显著优点 〔1〕。笔者于 2 0 0 0年开始用其治疗轻中度原发性高血压 ( EH) ,对其有效性和安全性与卡托普利进行前瞻性对比观察 ,报告如下。1　对象与方法1 .1 　 对象按 JNC- 提供的定义和标准 ,选择心内科住院或门诊的轻中度 EH患者 86例 ,剔除伴有严重心、脑、肾并发症和其他严重内科疾病患者 ,且除外继发性高血压。所有入选病例未经降压治疗或停服降压药物 2周以上。随机分为赖诺普利和卡托普利组 (各 43例 )。赖诺普利组中 ,男…     

心力衰竭新临床试验的意义与评价

近年对心力衰竭(heart failure,HF)研究的重点是寻找血管紧张素受体拮抗剂(angiotensin receptor blocker,ARB)与血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitors,ACEI)的比较及联合应用、非选择性β受体阻滞剂与β1受体阻滞剂比较和新开发的选择性醛固酮受体拮抗剂的新证据.近年公布的几项具有重要影响意义的HF药物治疗临床试验,反映了HF药物治疗的进展,并回答了有关HF治疗中人们关注的问题.     

The value of lowering blood pressure

According to the Canadian Heart Health Survey, only 14% of Canadian hypertensive patients are aware of their disease and are treated appropriately. One of the reasons for this could be that physicians are confused by an excess of confusing and contradictory information regarding the choice of drugs. Two recent publications may contribute to a much-needed simplification of the problem. The Blood Pressure Lowering Treatment Trialists' Collaboration published a meta-analysis based on 29 randomized trials that comprised a total of more that 162,000 participants. The treatment regimens were based on angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, beta-blockers and calcium channel blockers. The main finding of the meta-analysis was that treatment with any of the blood pressure-lowering regimens reduced the risk of major cardiovascular events, and the extent of these risk reductions was directly related to the degree of blood pressure lowering. The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) compared valsartan with amlodipine. At the end of the study, the reductions in blood pressure from baseline were 17.3/9.9 mmHg in the amlodipine group and 15.2/8.2 mmHg in the valsartan group (P<0.0001). There was a significantly lower incidence of myocardial infarction in the amlodipine group (4.1%) than in the valsartan group (4.8%). From these two studies, it would be reasonable to conclude that the treatment of elevated blood pressure has two main goals: to achieve a normal blood pressure and to produce a happy patient. The agent or agents used to obtain these goals are relatively unimportant.     

降压外还有什么?

治疗高血压的益处主要来自降压本身,并取决于降压幅度("唯血压论");还是除了降压之外,更强调药物本身的特性("药物作用论")?两种观点的交锋持续多年,2002年ALLHAT试验和2004年VALUE试验结果的公布使其争论更大.     

Non-pharmacologic measures for lowering blood pressure

Summary Nondrug measures have proven effective, to some extent, in lowering blood pressure, especially in mild hypertensives, in many well-controlled studies. The proven measures are reduction of a) salt (<5g/day), b) alcohol (<30ml/day) intake, and c) obesity, and d) regular physical exercise (30–60 minutes/day) and e) mental relaxation. The reported effectiveness of each of these measures ranges from one third to two thirds in mild hypertensives. Should all these nondrug measures, together with cessation of smoking, be applied in all mild hypertensives, it might help prevent their progression to moderate or even severe hypertension with complications, such as coronary heart disease in particular, thereby solving most of the problems that antihypertensive drugs have left behind.     

Significance of blood pressure self-measurement as compared with office blood pressure measurement and ambulatory 24-hour blood pressure measurement in pharmacological studies

With the increasing use of blood pressure self-measurement in pharmacological studies, the question arises as to whether this method can replace office blood pressure measurement or ambulatory 24-h blood pressure measurement for testing and comparing the efficacy of antihypertensives. Ambulatory 24-h blood pressure measurement or self-measurement available for analysis can be obtained in 70 to 90% of patients. Self-measurement shows a better correlation with the prognostically relevant ambulatory 24-h blood pressure measurement than office blood pressure measurement for appraising the antihypertensive effect. Although similar antihypertensive effects were found for ambulatory 24-h blood pressure measurement and self-measurement in the group comparison, substantial discrepancies can be observed in the individual patient owing to the different nature of these two methods of measurement. Both ambulatory 24-h blood pressure measurement and self-measurement are superior to office blood pressure measurement in terms of their reproducibility. This increases the sensitivity of clinical studies and reduces the number of cases required. Owing to the white-coat effect, variable compliance and drug holidays and their effects on the efficacy of antihypertensive medication are not detected by office blood pressure measurement and ambulatory 24-h blood pressure measurement. Self-measurement detects drug holidays, which are reflected in an increase of the blood pressure measurement values, and per se promotes compliance. Self-measurements and ambulatory 24-h measurements in pharmacological studies must be regarded as complementary, so that it is appropriate to use both methods whenever possible. Data management, data analysis and monitoring in pharmacological studies are facilitated by instruments with automatic data storage which allows telemonitoring.