老年高血压病的临床特点与治疗

目的:讨论老年人高血压的临床特点及合理治疗.方法:查阅国内外相关文献.结果与结论:老年高血压病的治疗应包括非药物的基础治疗和合理应用降压药物(利尿剂、β-受体阻滞剂、钙拮抗剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂以及α-受体阻滞剂).     

降压药的临床应用

国内外几个重要的高血压治疗指南将利尿剂、β-1受体阻滞剂、钙通道阻滞剂(CCB)、血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB)以及α-2受体阻滞剂作为一线抗高血压药物.     

降压药的临床应用

<正>在国内外几个比较重要的高血压治疗刊物(指南)将利尿剂、β2受体阻滞剂、钙通道阻滞剂(CCB)、血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB)以及α2受体阻滞剂作为一线抗高血压药物。六大类的抗高血压药物广泛应用,使高血压治     

AT-Ⅱ受体拮抗剂进展与临床评价(一)

<正> 高血压是人类最为常见的心血管疾病,有效地控制高血压可显著减少心脑血管相关并发症的发生率和死亡率。高血压治疗临床一直广泛推荐以利尿药和β-阻滞剂为首选药物,但血管紧张素转化酶抑制剂α_1-阻滞剂,钙拮抗剂α/β-阻滞剂和血管紧     

降压药物对糖代谢的影响

临床上高血压和糖尿病并存十分常见。在降压治疗中,相当多的治疗对象是糖尿病患者。降压药主要有六类：利尿剂、β-受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）、钙离子拮抗剂、血管紧张素Ⅱ（ATⅡ）受体拮抗剂及α-受体阻滞剂。了解这些药物对糖脂代谢的影响,对糖尿病并高血压患者的治疗具有临床意义。本文就降压药对血糖代谢的影响综述如下。     

我院2008年至2010年抗高血压药应用分析

目的 了解我院抗高血压药物的使用情况,为临床合理用药提供参考.方法 对2008年至2010年我院抗高血压药的销售数据利用Microsoft Excel 2000进行统计、分析.结果 我院抗高血压用药用药频度(DDDs)排名靠前的是血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂、钙拮抗阻滞剂.结论 抗高血压药物应用基本合理,钙拮抗剂、血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂在应用中占主导地位.     

六类降压药对糖、脂代谢的影响

临床上高血压和糖尿病并存十分常见。在降压治疗中．相当多的治疗对象是糖尿病患者。1999年2月WHO/ISH高血压治疗指南指出六类降压药：利尿剂、β-受体阻滞剂、血管紧张素转换酶抑制剂（ACEⅠ）、钙离子拮抗剂、血管紧张素（ATⅡ）受体拮抗剂及α-受体阻滞剂均适合作为一线降压药。了解这些药物对糖、脂代谢的影响，对糖尿病并高血压患者的治疗具有临床意义。     

降压药在治疗高血压及其合并症中的合理应用

临床治疗高血压的药物可分为利尿剂、血管紧张素转换酶抑制剂（ACEI）、血管紧张素Ⅱ受体阻滞剂（ARB）、钙拮抗剂、β受体阻滞剂、α受体阻滞剂、直接血管扩张剂等等,其作用机制各异。高血压患者应根据发病机制的不同而选择不同的药品。对合并症者,如何正确合理选择降压药物,以获得最佳疗效至关重要。现将高血压合并症降压用药选择简述如下。     

抗高血压药物的应用及器官保护的治疗进展

抗高血压药物的研究和应用较以前都有很大进展。目前，临床常用的抗高血压药物主要有以下8大类：利尿剂、β-受体阻滞剂、钙拮抗剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、α-肾上腺素能阻滞剂，周围血管扩张药及咪唑啉受体激动剂。     

1999年—2001年我院3类抗高血压药应用分析

目的 :探讨钙通道阻滞剂、血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂的临床应用特点及其发展趋势 ,以供临床合理选用抗高血压药物参考。方法 :通过我院 1999年～ 2 0 0 1年 3类抗高血压药物的应用情况进行统计、分析。结果与结论 :( 1)钙通道阻滞剂经过多年的临床应用 ,其降压效果已被临床接受 ;( 2 )血管紧张素转换酶抑制剂因其对靶器官的保护作用而愈来愈受到临床医师欢迎 ;( 3)血管紧张素Ⅱ受体拮抗剂是新型降压药 ,由于其对左心室肥厚和肾脏有保护作用 ,且极少引起血管紧张素转换酶抑制剂致干咳的不良反应 ,在临床上愈来愈受到重视。     

药物治疗顽固性高血压的研究进展

在高血压患者中,有15％～20％属于顽固性高血压。顽固性高血压具有更高的心血管事件的风险,给患者造成的危害也更严重。临床治疗顽固性高血压,需要结合患者的自身情况,选择不同的降压药联合用药。目前较为常用方案为血管紧张素转换酶抑制剂（或血管紧张素II受体阻滞剂）、钙拮抗剂和噻嗪类利尿剂3种药物组合,或由扩血管药、减慢心率药和利尿剂组合。本文综述了治疗顽固性高血压的联合用药方案和药物选择等方面的研究进展,为更好地治疗该病提供借鉴。     

门诊高血压患者用药情况调查分析

目的探讨我院门诊高血压药物的应用现状和趋势。方法调查分析我院门诊就医的高血压患者治疗药物处方7 920张,分析抗高血压药物的使用情况及治疗方案,监测药物使用的合理性。结果我院门诊最常用的降压药有7类20个品种,其中钙拮抗剂(CCB)占35%、β-受体阻滞剂占21%、血管紧张素转化酶抑制剂(ACEI)占18%、血管紧张素Ⅱ受体拮抗剂(ARB)占13%、利尿剂占9%、复方制剂占3%和中药制剂占1%;单种药物治疗占46.2%,联用2种或2种以上药物治疗占53.8%。硝苯地平缓释片(14.27%)、贝那普利(11.7%)和美托洛尔(11.4%)在同类药物中使用率最高。结论我院门诊抗高血压药物应用种类及降压治疗方案基本符合中国高血压防治指南及个体化治疗方案,应用长效抗高血压药物制剂及合理的联合用药是当今高血压治疗的主流。     

我院2003～2006年抗高血压药利用分析

目的:评价我院抗高血压药利用情况及趋势。方法:对我院2003年1月~2006年9月抗高血压药应用品种、销售金额、用药频度(DDDs)进行统计、分析。结果:抗高血压药销售金额逐年上升,钙拮抗药、血管紧张素转换酶抑制剂、血管紧张素受体Ⅱ拮抗药销售金额一直列前3位,单品种排序厄贝沙坦和左氨氯地平销售金额列第1、第2位,在DDDs排序中氢氯噻嗪和美托洛尔列前2位。结论:我院抗高血压药应用符合“高血压防治指南”。     

上海市长宁区新华街道社区卫生服务中心2010—2012年门诊药房抗高血压药应用情况分析

目的：分析上海市长宁区新华街道社区卫生服务中心2010-2012年门诊药房抗高血压药的应用情况,为临床合理用药提供参考。方法：对本中心2010—2012年门诊药房抗高血压药的用药金额、用药频度（DDDs）和药品日均费用进行排序,对用药金额／DDDs排序比值进行分析。结果：本中心门诊药房用量和金额在2011年基本药物政策执行时受各方因素影响下降,2012年恢复正常,日均费用逐年降低,复方抗高血压药制剂使用逐年增加。钙通道阻滞剂（CCB）和血管紧张素Ⅱ受体拮抗剂（ARB）是降压治疗主流药物,主要品种用药金额序号和用药频度序号比值为0．4～3结论：本中心口服抗高血压药使用结构基本合理,基本药物政策执行后日均费用下降。长效抗高血压药是目前高血压治疗的主要药物。基本药物政策惠民利民。     

Pharmacogenetics of antihypertensive treatment

Hypertension is a common disorder associated with increased cardiovascular morbidity and mortality. Unfortunately, in the US only about one-third of those who are aware of their hypertensive status have their blood pressure adequately controlled. One reason for this is the variable and unpredictable response individuals have to pharmacologic treatment. Clinicians often resort to "trial-and-error" to match patients with effective drug treatment. Hypertension pharmacogenetics seeks to find genetic predictors of drug response. To date, more than forty studies have investigated associations between genetic polymorphisms and response to antihypertensive drugs. Angiotensin-converting enzyme inhibitors and beta blockers have been most frequently studied, followed by angiotensin II blockers, diuretics, adrenergic alpha-agonists, and calcium channel blockers. Renin-angiotensin-aldosterone system genes have been the most widely studied, with the angiotensin-converting enzyme I/D variant being typed in about one-half of all hypertension pharmacogenetic studies. In total, 160 possible gene polymorphism-drug interactions have been explored, with about one-quarter of these showing that genes predict drug response. However, disparate and conflicting findings have been the rule rather than the exception, and the discovery of clinically relevant antihypertensive drug-response genes remains elusive. While there is a growing enthusiasm that pharmacogenetics of hypertension is important, the translation of pharmacogenetic findings to clinical practice in the future will depend on additional studies to enhance our pharmacogenetics knowledge base, the availability of pharmacogenetic screening tests that are affordable and easy to implement in clinical practice, a cohort of clinicians who are trained to interpret genetic test results, and health care systems that pay for them. Caution regarding the future of hypertension pharmacogenetics is warranted.     

Angiotensin receptor blockers in hypertension and cardiovascular diseases

Angiotensin receptor blockers are the newest class of antihypertensive agents marketed for the treatment of hypertension. There is now an important amount of evidence indicating that this class of drugs exerts beneficial effects in patients with a variety of cardiovascular disorders. Evidence-based medicine includes well controlled studies with mortality and morbidity endpoints in patients with left ventricular dysfunction after a myocardial infarction, congestive heart failure, cerebrovascular disease, type-2 diabetic subjects with renal dysfunction and high-risk hypertensive patients. In addition to these hard endpoints, treatment with angiotensin receptor blockers prevents the development of type-2 diabetes, promotes a more pronounced regression of left ventricular hypertrophy, decreases microalbuminuria and proteinuria in renal patients, ameliorates coronary and peripheral vascular endothelial dysfunction and decreases plasma levels of several markers of vascular inflammation. In summary, angiotensin receptor blockers are antihypertensive drugs with a very good profile in terms of efficacy, tolerability and cardiovascular protection. They represent an important step in the search for the ideal antihypertensive agent.     

Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: a population-based cohort study

Purpose

Non-steroidal anti-inflammatory drugs (NSAIDs) are known to antagonize the effects of antihypertensive drugs, and these associations can lead to an increase in arterial blood pressure. However, the impact of NSAIDs on hypertension treatment management in large-scale populations remains poorly evaluated. We examined whether the introduction of NSAID into the treatment regimen would induce an intensification of hypertension treatment (defined as the introduction of a new antihypertensive drug).

Methods

We conducted a cohort study involving 5,710 hypertensive subjects included in the French health insurance system database who had been treated and stabilized with their antihypertensive therapy and not exposed to any NSAID between 1 April 2005 and 1 April 2006. The maximum follow-up duration was 4?years.

Results

Adjusted hazard ratios (HR) for hypertension treatment intensification were 1.34 [95?% confidence interval (CI) 1.05–1.71] for NSAIDs in general, 1.79 (95?% CI 1.15–2.78) for diclofenac and 2.02 (95?% CI:1.09–3.77) for piroxicam. There were significant interactions between NSAIDs and angiotensin converting enzyme inhibitors (ACEIs; HR? 4.09, 95?% CI 2.02–8.27) or angiotensin receptor blockers (ARBs; HR?3.62, 95?% CI 1.80–7.31), but not with other antihypertensive drugs.

Conclusions

Exposure to NSAIDs leads to an intensification of hypertension treatment, especially in patients treated with ACEIs or ARBs. Renin–angiotensin system blockers should be avoided whenever NSAIDs are prescribed.     

Patterns in the drug treatment of hypertension in Auckland, 1982-7

This paper examines the pattern of drug treatment of hypertension in Auckland in the period 1982 to 1987 using data from a representative sample of the adult population interviewed in 1982 and followed up in 1987. In 1982 the age standardised prevalence of antihypertensive treatment for people aged 40-64 years was 12.2% (95%Cl 10.4, 14.0) and in 1987 it was 10.2% (95%Cl 8.5, 11.8). Over the five year period of this study, 6% of the sample untreated in 1982 began treatment with antihypertensive medication, while 24% of those on drugs in 1982 had stopped treatment by 1987. The most common medications used in both 1982 and 1987 for hypertension were diuretics and beta blockers. Over the five year period diuretic use fell and beta blocker use remained constant. In 1982 3% of hypertensives were taking a calcium antagonist but in 1987 13% were on these drugs and a further 13% were using ACE inhibitors. This study suggests that the prevalence of drug treatment for hypertension has plateaued in New Zealand; coincidentally there is a trend towards use of more expensive drugs.