沙库巴曲缬沙坦对比血管紧张素受体阻滞药治疗原发性高血压的疗效:网状荟萃分析

目的比较沙库巴曲缬沙坦与其他临床常见的血管紧张素受体阻滞药(ARB)在原发性高血压患者中的降压效果。方法采用网状荟萃分析,计算机检索了PubMed、EMBASE、Cochrane Library、Medline、Medline In-process和中国生物医学文献数据库,检索时间截至2020年10月20日,纳入比较沙库巴曲缬沙坦或其他临床常见的ARB或安慰剂治疗原发性高血压的随机对照试验。观察结局主要包括治疗8周后诊室坐位收缩压和舒张压的变化以及总体血压达标率。结果共纳入39项研究。与安慰剂相比,沙库巴曲缬沙坦治疗8周后对诊室坐位收缩压降压效果显著[-16.24(95%CI-19.03～-13.49) mm Hg]。概率排序图和累积排序曲线下面积(SUCRA)结果显示,对于诊室坐位收缩压和舒张压、总体血压达标率结局,与ARB相比,沙库巴曲缬沙坦的降压效果最佳(SUCRA分别为91.39%,85.06%,91.26%)。结论对于原发性高血压患者,沙库巴曲缬沙坦降压效果优于其他临床常见的ARB。     

沙库巴曲缬沙坦对原发性高血压患者血压昼夜节律的影响

目的 探讨沙库巴曲缬沙坦对血压昼夜节律的影响。方法 对就诊于我院心内科30例原发性高血压患者改用沙库巴曲缬沙坦治疗,收集降压治疗前后的临床情况、动态血压、B-型钠尿肽、尿酸等临床资料,比较改药前后患者血压昼夜节律的变化。结果 改用沙库巴曲缬沙坦治疗高血压6周后,患者夜间血压下降率较改药前增加（P<0.05）,昼夜节律异常比率由改药前的90%下降为63%(P<0.05);尿酸、B-型钠尿肽、胆固醇均明显低于改药前（P<0.05）。结论 沙库巴曲缬沙坦对原发性高血压患者具有较显著的降压效果,并能够将非杓型血压转变为杓型血压,从而有效改善高血压患者的血压昼夜节律,降低高血压的危险因素。     

缬沙坦与氨氯地平联合用药和缬沙坦单药治疗高血压合并2型糖尿病的对照试验

目的 评价缬沙坦与氨氯地平联合用药和缬沙坦单药治疗高血压合并2型糖尿病患者的有效性和安全性.方法 本研究为随机、双盲、平行对照研究.125例高血压合并2型糖尿病患者经2周洗脱期后,给予4周缬沙坦（80 mg/d）单药治疗,89例平均坐位舒张压（SeDBP）仍≥90 mm Hg的患者随机分为缬沙坦（80 mg/d）和氨氯地平（5 mg/d）联合用药治疗组及缬沙坦（80 mg/d）单药治疗组,共随机双盲治疗8周,以SeDBP下降差值和尿白蛋白排泄率（UAER）下降值作为主要疗效指标.54例患者（联合用药组28例,单药组26例）完成了24h动态血压监测,并作为降压疗效的评价指标.结果 随机、双盲治疗8周末,联合用药组SeDBP下降值为（13.7±5.8）mm Hg,达目的血压占65.9％;单药治疗组SeDBP下降值为（7.7±6.9）mm Hg,达目的血压占37.8％,两组组间比较差异有统计学意义（P＜0.01）.联合用药组尿白蛋白排泄率（UAER）为（7.15±2.13）μg/min,单药治疗组尿白蛋白排泄率（UAER）为（8.76±3.01）μg/min（P＜0.05）.24h动态血压监测结果,联合用药组和单药治疗组舒张压/收缩压（DBP/SBP）的谷/峰比率（T/P）分别为83.1％/76.0％和85.8％/79.5％（P＜0.05）.联合用药组与单药治疗组的不良反应发生率分别为5.2％和 10.7％（P＜0.01）.结论 缬沙坦与氨氯地平联合用药治疗高血压合并2型糖尿病的降压疗效明显优于缬沙坦单药治疗,且具有明显的肾脏保护作用.     

复方缬沙坦与血脂康联合治疗原发性高血压的临床研究

目的评价复方缬沙坦(缬沙坦80mg/氢氯噻嗪12.5mg)联合血脂康(600mg)治疗轻、中度原发性高血压患者的疗效和安全性。方法采用随机、双盲对照研究。将280例轻、中度高血压患者随机分为缬沙坦组和对照组。缬沙坦组患者给予复方缬沙坦(缬沙坦80mg/氢氯噻嗪12.5mg,1次/d)和血脂康(600mg,2次/d)治疗,对照组患者降压药物单用缬沙坦(80mg,1次/d)。治疗中每周测量血压。在治疗8周和结束时评价药物安全性和有效性。结果对于轻、中度原发性高血压患者,缬沙坦组较对照组血压进一步下降,达标率显著高于对照组。治疗结束时平均坐位收缩压均降低5mmHg,平均坐位舒张压多下降3mmHg,缬沙坦组和对照组患者中,血压控制<140/90mmHg者分别占54.1%和40.7%。结论轻、中度原发性高血压患者采用复方缬沙坦联合血脂康治疗,降压效果和达标率均优于单用缬沙坦。     

缬沙坦对老年高血压患者同型半胱氨酸的影响

目的 观察缬沙坦治疗前后老年高血压患者同型半胱氨酸(Hcy)的变化;探讨缬沙坦对老年高血压患者Hcy的影响. 方法 150例老年高血压2级患者和80例健康老年人进行Hcy的测定.再将高血压组随机分为A组和B组:A组给予缬沙坦(80 mg,1次/d)治疗;B组给予氢氯噻嗪(12.5 mg,2次/d)治疗,监测2组患者血压均能控制在＜ 140/90 mmHg,在给药前及给药1、3月后分别进行Hcy测定. 结果 老年高血压患者血清Hcy的含量高于对照组(P＜0.05).A组治疗后Hcy含量下降,并且下降幅度大于B组(P＜0.05). 结论 老年高血压病人Hcy增高,缬沙坦可降低Hcy的含量.     

复方缬沙坦治疗轻中度原发性高血压患者的疗效观察

目的评价复方缬沙坦（缬沙坦80mg／氢氯噻嗪12．5mg复方制剂）治疗经单用缬沙坦80mg控制不良的轻、中度原发性高血压患者疗效和安全性。方法采用多中心、双盲、双模拟、随机、活性药物对照、平行试验方法。对经2周洗脱期的轻、中度原发性高血压患者[坐位舒张压≥95mmHg（1mmHg=0．133kPa）且〈110mmHg]采用单药缬沙坦80mg／d治疗4周,在单药导入结束后,坐位舒张压仍〉190mmHg的864例患者按1：1随机、双盲分为复方缬沙坦组或缬沙坦80mg／d组,继续治疗8周。在治疗4周和结束时评估药物安全性及有效性。结果在轻、中度原发性高血压患者中复方缬沙坦每日1次比单用缬沙坦80mg／d血压进一步下降、达标率提高。治疗结束时平均坐位收缩压多降低3．5mmHg,平均坐位舒张压多下降2．2mmHg,血压控制〈140／90mmHg的患者在复方缬沙坦组和单用缬沙坦80mg／d组分别为53．9％及40．9％。结论轻、中度原发性高血压患者采用复方缬沙坦治疗组降压有效率及达标率均优于每日1次服用缬沙坦80mg／d组。复方缬沙坦适用于缬沙坦单药控制不良的轻、中度原发性高血压患者。     

缬沙坦联合苯磺酸氨氯地平对女性高血压患者血压谷峰比值与平滑指数的影响

目的探讨在女性高血压患者中联用缬沙坦与苯磺酸氨氯地平对于控制血压谷峰比值及平滑指数的作用。方法对我院63例女性高血压患者进行随机分组,将单用苯磺酸氨氯地平、单用缬沙坦和联用两者治疗者各纳入A组、B组和C组,分析并评估3组病例的临床治疗情况。结果与治疗前相比,三组患者的24hSBP、24hDBP、dSBP、dDBP、nSBP和nDBP水平均显著下降（均为P〈0.05）。且除24hDBP之外,C组治疗后其余指标均要较A组和B组改善更明显（P〈0.05）。C组治疗后的血压谷峰比值与平滑指数均要较A组和B组高（P〈0.05）。结论为女性高血压患者提供缬沙坦与苯磺酸氨氯地平治疗有确切效果,对于控制患者血压谷峰比值、平滑指数有重要意义。     

氨氯地平联合缬沙坦对原发性高血压患者血压控制情况的影响

目的 探讨氨氯地平联合缬沙坦对原发性高血压患者血压控制情况的影响.方法 选择2018年10月-2019年10月的100例原发性高血压患者为研究对象,随机分为对照组与观察组各50例,对照组采用缬沙坦治疗,观察组在对照组基础上加氨氯地平,对两组血压控制情况及不良反应发生率进行比较.结果 两组治疗前的舒张压与收缩压无明显差异(P>0.05),观察组治疗后的舒张压与收缩压均低于对照组(P<0.05);观察组不良反应发生率为10.00%,与对照组8.00%比较无明显差异(P>0.05).结论 氨氯地平联合缬沙坦可有效控制原发性高血压患者血压水平,且不会过多增加不良反应,值得推广.     

缬沙坦/氨氯地平复方片剂对单药控制不良的轻中度高血压患者的疗效观察

目的 评价缬沙坦(80 mg)/氨氯地平(5 mg)复方片剂(复方片剂)治疗经氨氯地平5 mg或缬沙坦80 mg控制不良的轻、中度原发性高血压患者疗效和安全性.方法 采用多中心、双盲、双模拟、随机、活性药物对照、平行试验方法进行两项临床研究.在两项研究中对经1～4周洗脱期的轻、中度原发性高血压患者[坐位舒张压≥95 mm Hg(1 mm Hg=0.133 kPa)且<110 mm Hg]分别采用单药氨氯地平5 mg或缬沙坦80 mg治疗4周,在单药导入结束后,坐位舒张压仍然≥90mm Hg且<110 mm Hg的患者随机进入复方片剂组或继续原有的单药治疗,共8周.其间,在治疗4周和试验结束时评估药物的安全性及有效性.结果 治疗结束时,复方片剂组平均坐位收缩压/平均坐位舒张压下降幅度较氨氯地平单药治疗组多4.4mm Hg/3 mm Hg(P<0.0001);较缬沙坦80 mg组多6.4 mm Hg/4.2 mm Hg(P<0.0001).两项研究中复方片剂组的血压控制率(血压<140/90 mmHg)分别为71.0%及71.2%,显著优于氨氯地平或缬沙坦单药治疗组,不良事件发生率与单药治疗组相当.结论 复方片剂组的血压控制率显著优于其两种成分(氨氯地平5 mg或缬沙坦80 mg)单药的治疗,且具有良好的安全性和耐受性.     

缬沙坦联合硝苯地平治疗高血压合并糖尿病的疗效观察

目的观察缬沙坦联合硝苯地平治疗高血压合并糖尿病的临床效果。方法根据入院顺序随机将106例患者分为观察组和对照组,每组53例,对照组采用单纯硝苯地平治疗,观察组采用缬沙坦联合硝苯地平治疗。比较两组患者疗效。结果血压控制效果观察组总有效率90.6%,对照组73.6%;观察组患者血肌酐水平、尿微量蛋白排泄率改善情况明显优于对照组。差异有统计学意义(P0.05)。结论缬沙坦联合硝苯地平治疗伴糖尿病的高血压患者血压控制效果更优,能有效降低肾功能损害,用药安全方便,值得临床推广应用。     

Zerebrale Folgen der Hypertonie

Hypertension is the most important risk factor for stroke and vascular dementia. Antihypertensive treatment reduces stroke risk by 40%. Most probably, all antihypertensive drugs are equally effective with the exception of alpha blockers. One study showed superiority of an angiotensin (AT) II antagonist versus beta blocker in patients with hypertension and left ventricular hypertrophy. Blood pressure is increased in many patients with acute stroke. In this phase, sudden drops in blood pressure should be avoided. All guidelines concerning antihypertensive treatment in acute stroke are not based on evidence. For secondary prevention, the combination of an angiotensin- converting enzyme (ACE) inhibitor and diuretic reduced strokes by 28% after transient ischemic attack (TIA) or a first stroke. Whether this is a drug-specific effect or due to lowering blood pressure per se is investigated at the moment. Antihypertensive treatment can reduce the incidence of vascular dementia and cognitive impairment.     

Prevention of dementia and cerebroprotection with antihypertensive drugs

High blood pressure is a major risk factor for stroke and is also closely correlated with cognitive decline and dementia. Indeed, most longitudinal studies showed that cognitive functioning is often inversely proportional to blood pressure values measured 15 or 20 years previously. Because of the aging of the population, the frequency of stroke and dementia will dramatically increase in the coming years. Therefore, the prevention of cerebrovascular and cognitive disorders represents a major challenge. Antihypertensive drugs have shown clinical benefits in both primary and secondary prevention of strokes. Consensus is generally that blood-pressure lowering represents the major determinant of the benefit conferred by the antihypertensive treatment for stroke prevention; however, recent studies have suggested some differences between classes of antihypertensive drugs. The results of therapeutic trials (Systolic Hypertension in Europe [Syst-Eur], Perindopril Protection Against Recurrent Stroke Study [PROGRESS]) open the way to the prevention of dementia (vascular or Alzheimer’s type) by antihypertensive treatments. These two studies suggest different mechanisms for the prevention of cognitive decline using antihypertensive drugs. In this context, reduced incidence of dementia should be the primary outcome of future trials comparing different classes of antihypertensive drugs.     

Prevention of stroke and myocardial infarction by amlodipine and Angiotensin receptor blockers: a quantitative overview

In the present quantitative overview of outcome trials, we investigated the efficacy of amlodipine or angiotensin receptor blockers in the prevention of stroke and myocardial infarction in patients with hypertension, coronary artery disease, or diabetic nephropathy. The analysis included 12 trials of 94 338 patients. The analysis of trials involving an amlodipine group showed that amlodipine provided more protection against stroke and myocardial infarction than other antihypertensive drugs, including angiotensin receptor blockers (-19%, P<0.0001 and -7%, P=0.03) and placebo (-37%, P=0.06 and -29%, P=0.04). The analysis of trials involving an angiotensin receptor blocker group showed contrasting results between trials versus amlodipine and trials versus other antihypertensive drugs for stroke (+19% versus -25%; P<0.0001) and myocardial infarction (+21% versus +1%; P=0.03). The results of 3 trials comparing an angiotensin receptor blocker with placebo were neutral (P> or =0.14). The within-trial between-group difference in achieved systolic pressure ranged from -1.1 to +4.7 mm Hg for trials involving an amlodipine group and from -2.8 to +4.0 mm Hg for trials involving an angiotensin receptor blocker group. The metaregression analysis correlating odds ratios with blood pressure differences showed a negative relationship (regression coefficients: -3% to -8%), which reached statistical significance (regression coefficient: -6%; P=0.01) for stroke in trials involving an amlodipine group. In conclusion, blood pressure differences largely accounted for cardiovascular outcome.     

Arterial Hypertension and Stroke Prevention: An Update

High blood pressure (BP) is the most important modifiable risk factor for stroke and other vascular diseases. Evidence from randomized controlled trials supports the use of antihypertensive drugs to lower blood pressure for stroke prevention. There is some evidence that specific classes of antihypertensive drugs have different effects and/or their pharmacological actions differ in patient subgroups. This review evaluates the development of antihypertensive therapies and the latest studies of arterial hypertension and stroke prevention: HOPE trial (ramipril versus placebo), ALLHAT trial (CCB or/and Angiotensin-Conventing enzyme Inhibitors (ACE-Is) versus diuretic), LIFE trial (losartan versus atenolol), and PROGRESS trial (perindopril or/and indapamide versus placebo). Despite the results of these relevant clinical trails, some aspects still remain unresolved. Future clinical trials on hypertension and stroke prevention should answer the following questions: Does lowering BP reduce stroke risk due to specific drug effect or class effect? Are angiotensin II receptor blockers (ARBs) better than ACE-Is? Should ACE-Is and ARBs be considered routinely for either high-risk stroke patients or patients with history of stroke or transient ischemic attack, irrespective of blood pressure? What is the role of lifestyle in BP control?     

Arterial hypertension and stroke prevention: an update

High blood pressure (BP) is the most important modifiable risk factor for stroke and other vascular diseases. Evidence from randomized controlled trials supports the use of antihypertensive drugs to lower blood pressure for stroke prevention. There is some evidence that specific classes of antihypertensive drugs have different effects and/or their pharmacological actions differ in patient subgroups. This review evaluates the development of antihypertensive therapies and the latest studies of arterial hypertension and stroke prevention: HOPE trial (ramipril versus placebo), ALLHAT trial (CCB or/ and Angiotensin-Conventing enzyme Inhibitors (ACE-Is) versus diuretic), LIFE trial (losartan versus atenolol), and PROGRESS trial (perindopril or/and indapamide versus placebo). Despite the results of these relevant clinical trails, some aspects still remain unresolved. Future clinical trials on hypertension and stroke prevention should answer the following questions: Does lowering BP reduce stroke risk due to specific drug effect or class effect? Are angiotensin II receptor blockers (ARBs) better than ACE-Is? Should ACE-Is and ARBs be considered routinely for either high-risk stroke patients or patients with history of stroke or transient ischemic attack, irrespective of blood pressure? What is the role of lifestyle in BP control?     

Preventing of stroke by antihypertensive drugs: potential and limitations

Analysis of controlled randomized studies of efficacy of antihypertensive drugs in primary and secondary prevention of stroke is presented. Basing on this analysis a conclusion is made that in patients with hypertension representatives of all 4 main classes of antihypertensive drugs prevent stroke with similar efficacy. Magnitude of reduction of risk of both first and recurrent stroke is determined not by the class of a drug but by degree of blood pressure lowering. Special emphasis is made on necessity of careful approach to blood pressure lowering in elderly patients.     

Diuretics for cardiovascular prevention in the elderly

High blood pressure (BP) is a major risk factor for cardiovascular and cerebrovascular diseases in elderly subjects. Antihypertensive drugs have shown clinical benefit both in primary and secondary prevention of cardiovascular events. If BP lowering represents the major determinant of the effects conferred by the antihypertensive treatment for prevention, recent studies have suggested some differences between classes of antihypertensive drugs according to age. Based on the available clinical data, the recent medical guidelines have recommended thiazide-type diuretics as the preferred drug for the treatment of elderly hypertensive patients, followed by long-acting calcium antagonists. Indeed, diuretics constitute one of the most valuable classes of antihypertensive drugs, and in the elderly, diuretic-based treatment studies have been clearly shown to prevent major cardiovascular events, including stroke, heart failure and coronary heart disease.     

Schlaganfall und Hypertonie

Arterial hypertension is the most important risk factor for stroke. Many interventional trials have unambiguously proven the benefit of antihypertensive therapy in both primary and secondary prevention for all age categories. No recommendation for any single antihypertensive substance for the primary prevention of stroke exists. Achieving the therapeutic goal (normotension) is the crucial factor. In most patients, multiple combinations of antihypertensive drugs are required to do this. For high-risk patients and in secondary prevention, substances inhibiting the renin-angiotensin-system, especially combined with calcium antagonists and indapamid, may be advantageous, while beta-blockers appear to be less well suited. In patients suffering from left-ventricular hypertrophy or atrial fibrillation, sartanes are the best-documented drug class. As TIA or stroke will often disturb the normal circadian rhythm of blood pressure and eliminate the usual night-time drop, monitoring of the therapeutic results must include ambulatory 24h measurements. The interrelation between vascular dementia and hypertension is by now also considered proven. An early start of antihypertensive treatment can prevent the development of dementia and impaired cognitive function.     

Prevention of Second Strokes Through Blood Pressure Lowering: Update for 2011

Hypertension has long been recognized as a major risk factor for stroke, and lowering blood pressure has been shown to be effective in preventing first-time strokes. However, it is only over the past decade or so that lowering blood pressure has been shown to also be effective in preventing recurrent strokes. Large recent studies have quantified the effect of blood pressure lowering on stroke prevention, and increasing attention is being paid to variability of blood pressure rather than usual blood pressure values in determining stroke risk and explaining some of the class differences between various antihypertensives in stroke prevention. On the flip side, however, large trials aimed at showing a benefit of angiotensin receptor blockers on stroke prevention, above and beyond blood pressure lowering, have not yielded positive results. Many important questions such as the optimal time to initiate antihypertensive treatment after a stroke, the choice of the antihypertensive agent, and the optimal blood pressure goal after a stroke remain to be determined.     

Optimal Treatment of Hypertension and Cardiovascular Risk Reduction in African Americans: Treatment Approaches for Outpatients

African Americans have a higher prevalence and greater severity of hypertension compared with whites and therefore have a higher prevalence of many disease-related complications, such as coronary heart disease, stroke, and end-stage renal disease. Minorities have been, until recently, underrepresented in large clinical trials, leading to a lack of outcome data for these patient groups. However, accumulating data confirm the benefit of aggressive blood pressure-lowering therapy in this population. These studies also show that most patients require combination therapy to achieve adequate blood pressure reduction, particularly high-risk patient groups that have lower target blood pressure goals. All of the available antihypertensive agents are effective in African Americans. Recent studies suggest that regimens containing a thiazide-type diuretic are unsurpassed in blood pressure lowering and prevention of major clinical complications, and they cost less. Thus, while other agents may be required for selected clinical indications or for blood pressure control, diuretics should be drugs of first choice or included in most antihypertensive regimens especially in African American hypertensives.