改善临床评价,提高高血压治疗疗效

高血压已经成为威胁人类健康、高发病率和高死亡率的世界性问题。近期调查表明,目前对高血压患者的检出率、治疗率及其血压控制率均较低。诊断方法仍需改进。最近的临床试验表明,β受体阻断剂在治疗轻微高血压方面并不是理想的一线治疗药物,应被用于伴随心脏病的高血压。钙离子拮抗剂和噻嗪类利尿剂被认为是治疗55岁以上高血压病人的首选药物。对于55岁以下的高血压病人,初始治疗药物选择ACE转化酶抑制剂比钙离子拮抗剂和噻嗪类利尿剂效果好。ACE转化酶抑制剂与钙离子拮抗剂或噻嗪类利尿剂配伍使用是临床上常见的联合用药方案。有研究显…     

一线降压药选评

<正> 高血压药物治疗的新概念是药物治疗不仅仅以降压为目的,而是在降压的同时必须保护靶器官(心、脑、肾)不受损伤为目标。 1类别选择根据WHO国际高血压学会的高血压治疗指南,主要选择利尿剂、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受体拮抗剂和α-受体阻滞剂6类药物作为一线药物。中国高血压联盟选择前5类作为一线药物。     

联合抗高血压药物治疗应成为普遍适用临床策略

2007年<欧洲高血压治疗指南>再次强调了高血压患者必须降压达标.然而,目前临床上单用搞高血压药物治疗所获得降压达标率不足50%.已有的临床研究资料显示,超过60%的高血压患者需要至少两种以上搞高血压药物联合治疗才能使高血压控制达标.因此,联合搞高血压药物治疗应成为普遍适用的初始冶疗临床策略.     

降压药的合理应用

<正> 一、高血压初期用药的选择 过去在国外,大多数医生一直选用利尿剂为首选药物,后来,β受体阻滞剂得到了普遍接受,美国高血压联合委员会推荐将上述两种药物作为高血压的首选药物。 而国内对轻、中度高血压的治疗则不同于国外的常用疗法(β阻滞剂+噻嗪类利尿剂)。自八十年代初,我国引进了钙拮抗剂及ACEI,并经大量的临床观察,目前这两类药物(特别是硝苯地平和卡托普利)已广泛应用于高血压的治疗中。     

高血压药物治疗进展

［摘要］大量循证医学资料表明,要改善高血压的长期预后,绝大多数患者通常需要终身服用降压药物,而且大多数需要服用2种以上抗高血压药物.如何根据患者的具体情况,科学合理的使用降压药物,以提高长期治疗的效果和依从性,是广大临床医师和患者共同面临的重要问题.该文参阅近年来国内外降压药物治疗的文献和高血压治疗新指南,结合作者的临床用药经验,总结降压药物的新进展和研究新动向.     

我院降压药物应用情况调查研究

目的 分析降压药物的应用情况.方法 选取临床诊断为原发性高血压的798张处方.分析患者的一般情况、抗高血压药的用药品种、数量、联用方案、用药频度(DDDs)及排序.结果 798张处方中以男性和60～70岁患者居多.处方数目由多到少依次为钙通道拮抗剂、β受体阻滞剂、血管紧张素转换酶抑制剂、血管紧张素受体拮抗剂、利尿剂、复方制剂及其他.DDDs排序前10位的药物分别为缬沙坦、坎地沙坦酯、非洛地平、吲达帕胺、氨氯地平、氢氯噻嗪、硝苯地平、尼莫地平、卡托普利和贝那普利.结论 患者高血压控制率较高,用药基本合理.临床应用降压药物应综合分析患者血压水平,制定合理的治疗方案.     

AT-Ⅱ水平对替米沙坦治疗高血压影响的探讨

根据有关报道,2006年我国高血压患者已达2亿。对于所有高血压患者,我国高血压防治指南要求高血压控制至少应低于140/90mmHg,如能耐受可进一步降低。对于伴糖尿病及心血管高危或极高危因素的患者,血压控制在130/80mmHg以下。目前指南推荐的降压药物5类,但无明确首选哪类药物的标准或指证。     

利尿降压药的评价

1994年WHO提出“阶梯治疗方案”,其中第一线降压药物,包括利尿剂与B受体阻滞剂2类,其后发现长期使用噻嗪类利尿剂可引起胆固醇及甘油三脂增高,增加冠心病的危险．故对其作为第一线降压药物在国际上引起了争论。美国学者认为噻嗪类利尿剂仍为首选降压药物,经5年长期观察血脂改变不明显,而瑞典等国一些学者则持反对态度,主张以口受体阻滞剂作为首选药物,并推荐美托洛尔治疗高血压病。早在1988年美国高血压国家联合委员会(JNC)提出新的阶     

我院降压药物应用情况调查研究

目的分析降压药物的应用情况。方法选取临床诊断为原发性高血压的798张处方。分析患者的一般情况、抗高血压药的用药品种、数量、联用方案、用药频度（DDDs）及排序。结果 798张处方中以男性和60～70岁患者居多。处方数目由多到少依次为钙通道拮抗剂、β受体阻滞剂、血管紧张素转换酶抑制剂、血管紧张素受体拮抗剂、利尿剂、复方制剂及其他。DDDs排序前10位的药物分别为缬沙坦、坎地沙坦酯、非洛地平、吲达帕胺、氨氯地平、氢氯噻嗪、硝苯地平、尼莫地平、卡托普利和贝那普利。结论患者高血压控制率较高,用药基本合理。临床应用降压药物应综合分析患者血压水平,制定合理的治疗方案。     

"洛汀新""有奖问答

洛汀新”——高血压核心用药,全面保护心、脑、肾 洛汀新(盐酸贝那普利)是血管紧张素转换酶抑制剂(ACEI)类抗高血压药物的代表,被世界卫生组织和中国高血压防治指南共同推荐为抗高血压治疗的一线用药。随着医学科学的发展,高血压治疗的观念发生崭新变化,从原来单纯降压,发展到全面保护心、脑、肾。最新的权威高血压指南(美国高血压     

Optimal drug treatment of systolic hypertension in the elderly

Approximately two-thirds of the elderly population has hypertension, mainly of the isolated systolic hypertension (ISH) type. However, while large-scale, randomized controlled intervention trials have demonstrated that treatment of ISH reduces rates of total mortality, cardiovascular mortality and stroke in older hypertensives, control of ISH in the elderly remains poor. The aim of this review of drug treatment of ISH in the elderly is to provide a succinct, practical and clinically orientated guide that summarizes international recommendations and practices with special emphasis on newer approaches. Knowledge of pathophysiological changes in older subjects (decreased elastic artery compliance, reduced plasma renin activity, increased salt sensitivity) and evidence from epidemiological surveys and randomized controlled trials give clear clues that thiazide(-like) diuretics and long-acting dihydropyridine calcium channel antagonists are the drugs of choice in the treatment of ISH. Thus, based on this evidence, American, European and international guidelines for hypertension management still offer the best available recommendations for optimal treatment of ISH in the elderly. Newer combination treatments, especially the fixed combination of a dihydropyridine calcium channel antagonist and an ACE inhibitor, have valuable benefits in terms of efficacy and tolerability. Use of nitrates added to other antihypertensive medications can provide the practising physician with a further unconventional therapeutic strategy.     

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。     

Antihypertensive Drugs

For most patients with systemic hypertension, long-term drug treatment is indicated and is beneficial. There is overwhelming evidence to suggest that antihypertensive drugs offer protection against complications of hypertension. Whereas nondrug therapeutic options should be implemented in all patients, a vast majority will require pharmacological treatment to achieve goal blood pressure levels. Fortunately, a number of drugs are available to accomplish successful treatment of hypertensive disorders. While it is conventional to initiate treatment with a single drug, a suitable combination of drugs is often required to control the blood pressure effectively. Although diuretics and β-blockers are effective and well tolerated, other classes of drugs are being increasingly used as the initial choice of therapy for hypertension. Every class of antihypertensive drugs offer advantages and some disadvantage; the physician should weigh the benefits and risks in selecting one drug over another. While the clinical parameters are followed in the management of patients with hypertension, it is also necessary to monitor the patients’ biochemical profile periodically in order to modify and adjust the therapy accordingly. A careful selection of drug therapy along with close follow-up offers the best prospect to reduce the burden of morbidity and mortality in hypertension. This article provides an overview of drugs in the management of patients with hypertension.     

中成药处方点评的标准与尺度探索(一):超说明书剂量用药

中成药处方点评是推动医院中成药合理应用的重要环节,也是中药临床药学的重要内容.然而,由于中成药特殊的治疗学背景和时代特征,单纯以说明书为标准的处方点评存在一定局限性,并突出表现在超说明书剂量用药方面.本研究基于目前中成药超说明书剂量用药的点评现状,结合古今文献,从中药现代常用量与经方本源剂量的对比、中成药质量和疗效的不稳定性、中成药说明书的欠规范性共3个角度,并援引十余种常见中成药临床应用中的真实超剂量使用案例,尝试剖析中成药超剂量用药的潜在“合理性”.在此基础上,提出3点建议:树立中成药使用剂量的上下限理念、区分管理低风险药品和高风险药品、根据不同适应证采用等级化剂量,从而规范超剂量用药的点评标准,探索超剂量用药的点评尺度,为中成药合理用药提供思考.     

加快现代中药研发提高中医药国际影响力

中药以及中医药现代化的概念应随现代科技水平的发展而不断延伸。文中阐述了中药现代化的重要性,借鉴有关文献,对中药物质基础、组方原则、药性理论等中医药基础理论进行分析,探讨现代中药提取、分离技术的特点和应用。提出实现中药国际化,不仅要实现中药标准国际化,确保中药安全性和疗效,而且要开发一批按组分(成分)配伍组方的"现代中药",以适应中药国际化和医学发展趋势的需要。     

联合用药——高血压病人血压控制达标的基本策略

本文介绍了2003年《美国预防、检测、评估和治疗高血压全国联合委员会第七次报告（JNC7）》、2003年欧洲高血压指南、2005年中国高血压指南及2006年英国成人高血压管理指南的重要内容，通过对指南的解读和一系列大型随机对照试验结果的回顾，阐述高血压药物联合治疗对提高血压达标控制率的意义。     

Factors Influencing Family Physician Adherence to Hypertension Treatment Guideline Recommendations on the Initiation of Pharmacotherapy

Background

Family physicians do not prescribe antihypertensive medication according to current guidelines. This study investigates possible reasons for this. The objectives were to measure the knowledge, attitude and stated practice of family physicians to the initiation of pharmacotherapy for uncomplicated hypertension and to explore the reasons why clinical practice differs from guideline recommendations.

Study design

A cross-sectional postal survey conducted between June and October 1999. Simple frequency analysis and a χ² test comparing family physician characteristics and responses.

Methods

A three-phase postal survey was undertaken of a random sample of family physicians. Telephone and facsimile contact was made to non-responders. The survey instrument included respondent characteristics, preference for initiation of antihypertensive drug therapy and their opinion of efficacy, adverse effects and long-term safety, as well as knowledge of guidelines.

Participants

Family physicians in the state of Victoria, Australia.

Main outcome measures and results

Ranked preference of drugs for uncomplicated hypertension. Opinion of drug efficacy, adverse effects, safety and cost. Knowledge of guidelines for first-line antihypertensive drugs. Newer agents are preferred to older agents in the initiation of antihypertensive drug therapy contrary to current guideline recommendations. Newer agents were thought to be more efficacious, have better short- and long-term adverse effect profiles and be more expensive than older agents. Younger doctors most often held these attitudes. Guidelines influenced decision making but were not the most important factor.

Conclusions

There is a demonstrable need for governments to invest in the promotion of accurate information on drugs through continuing education of prescribers and facilitating the production of standardized paper and web-based clinical guidelines. A program of targeted investment in clinical trials that examine the justification for more expensive classes of agents should also be considered in appropriate circumstances.     

The role of olmesartan medoxomil in the management of hypertension

Intensive blood pressure control is a desirable and obtainable goal in patients with hypertension, according to the most recent treatment guidelines from Europe and the US. Achieving target blood pressure depends on the efficacy of antihypertensive treatment and patient compliance. Olmesartan medoxomil, a non-peptidergic angiotensin AT1 receptor antagonist, has been shown to be effective and well tolerated. Continuation of initial treatment is higher with AT1 receptor antagonists than for any other class of antihypertensive drugs. Olmesartan medoxomil may also have end-organ protective effects that provide additional clinical benefit. Optimal blood pressure control may be achieved faster if initial treatment contains the most efficacious and well tolerated antihypertensive drug or drugs. The ongoing European study, known as OLMEBEST (Efficacy and safety of OLMEsartan: reduction of Blood pressure in the treatment of patients suffering from mild to moderate ESsenTial hypertension), will provide important information on the use of olmesartan medoxomil as an initial treatment for hypertension.     

东莞部分社区医生高血压防治知识现状与《中国高血压防治指南））（2009年基层版）差异性分析

目的了解东莞部分社区医生高血压防治知识现状以及与〈〈中国高血压防治指南〉〉（2009年基层版）差异性。方法东莞市部分社区医生现场答卷,以调查高血压相关知识。结果社区医生中,能够掌握心血管病和高血压危险因素的有58％,能够掌握患者高血压其临床评价的有61％,能够掌握患者高血压应用非药物手段进行治疗其内容的有42％,能够掌握关于高血压流行趋势与现状的有38％,能够掌握关于血压水平分类的有38％,能够掌握高血压降压药物其治疗原则的有35％,能够掌握患者高血压其危险分层的有31％,能够掌握降压药物其分类的有30．6％,能够合理的选择患者降压药物的有28％,能够熟悉高血压患者其监测与评估程序的有22％,能够掌握对特殊人群应用降压药物进行治疗的有9％,能够联合应用降压药物对患者进行治疗的有ll％,513％的社区医生知道中国高血压指南,23．8％医生接受过指南相关内容培训。结论社区医生高血压防治知识有待提高,社区高血压治疗需规范和优化。     

发展监管科学，促进中药产业传承创新

2008年新药创制重大专项启动实施以来的10多年间,紧密围绕构建国家药物创新技术体系目标,为我国新药研发和公众用药安全提供了重要的保障,获得重大进展。药品监管科学是近十几年发展形成的前沿学科,受到世界科学界和管理界的重视。本文秉着中药监管科学发展与现实存在问题,需要理论创新、药物创新、技术创新、方法创新和应用创新。中药监管科学研究计划是国家推进的9个监管科学行动计划之一。启动以中药临床为导向的中药安全性评价研究,构建中药安全性和质量控制体系。作者认为通过监管科学研究,制定科学规范的中药质量标准和评价指导原则和技术指南,推进中药材、中药饮片和中成药,特别是经典名方制剂品种示范研究,有利于中药产业健康科学发展。在本文中还结合当前的中药监管科学问题,加强药材和饮片的基础研究、中药注射剂质量疗效的再评价研究、经典名方的开发和简化申请的监管科学研究,提出监管科学研究顶层设计建议,制定技术原则与技术指南,有利于药典品种和市场产品的质量和临床有效性再评价。