我院2005~2007年抗高血压药应用分析

目的:评价我院抗高血压药的应用现状及趋势。方法:对我院2005~2007年抗高血压药销售金额、用药频度及日均费用等进行统计、分析。结果:3年来我院抗高血压药销售金额、用药频度显著上升,以钙拮抗药、血管紧张素转换酶抑制剂、利尿降压药等为主;血管紧张素Ⅱ受体拮抗药用量逐年增加。结论:我院抗高血压药应用结构基本合理;开发价廉、降压效果明显、不良反应少的长效复方制剂具有重要的临床意义。     

2007～2009年我院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2007-2009年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,钙拮抗药与血管紧张素转换酶抑制剂销售金额一直列前2位,单品种销售金额与DDDs排序同样显示钙拮抗药与血管紧张素转换酶抑制剂列前2位。结论我院抗高血压药的应用状况与国内、外总体用药状况基本相符,钙拮抗药和血管紧张素转换酶抑制剂最常用。     

广东地区抗高血压药应用状况

目的:了解抗高血压药在广东地区的应用状况及其发展动向.方法:对2000～2002年抗高血压药用药金额、用药频度及日均费用的变化进行统计、分析.结果:3年来,在各类降压药中,只有血管紧张素Ⅱ受体拮抗药的DDDs市场百分率和销售金额市场百分率均逐年显著上升;血管紧张素Ⅱ受体拮抗药,以其高效、不良反应少、作用缓和、长效稳定、服用方便等优点,在广东地区每年平均以3%增长.结论:血管紧张素Ⅱ受体拮抗药、长效钙拮抗药和吲达帕胺,逐渐广为医师和高血压患者选用;随着大量血管紧张素Ⅱ受体拮抗药的上市和价格下调,有望3～5年后逐渐取代目前ACEI在降压药中的地位.     

我院2004年～2006年抗高血压药应用分析

对我院2004年--2006年抗高血压药的销售金额、用药频度及日均费用等进行统计、分析。结果我院抗高血压药的销售金额呈增长趋势，排在前10位的是钙通道阻滞药、血管紧张素转换酶抑制药、血管紧张素受体拮抗药和α受体阻滞剂。从单品种销售金额看，排在前10位的主要是安全有效、上市不久、价格较贵的新药。DDDs构成比和销售金额构成比上，钙通道阻滞药呈下降趋势，而血管紧张素受体拮抗药呈上升趋势。     

比对6个版次的《新编药物学》看我国临床降压药物发展

目的:了解我国临床降压药物的发展状况。方法:对《新编药物学》第11～16版(1981～2007年)中降压药物的品种进行统计分析。结果与结论:1997年(第14版)以来,我国临床降压药物有了较大发展,主要是增加了肾上腺素受体阻滞药、钙拮抗药、血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体阻滞药的品种,为高血压患者提供了更多安全、有效的药物,降低了病死率。     

我院2004年～2005年抗高血压药利用分析

目的:评价我院2004年～2005年抗高血压药的应用状况及发展趋势。方法:对我院2004年～2005年抗高血压药的销售金额、用药频度及限定日费用等进行统计、分析。结果:我院抗高血压药的销售金额呈增长趋势,排在前4位的是钙通道阻滞药、血管紧张素转换酶抑制药、血管紧张素受体拮抗药和β肾上腺素受体阻滞药。从单品种销售金额看,排在前10位的主要是安全有效、上市不久、价格较贵的新药。用药频度居前15位的主要是降压效果肯定且价格相对低廉的品种。结论:我院抗高血压药的应用状况与国内、外总体用药状况基本相符。     

成都地区17家医院2007-2009年抗高血压药利用分析

目的:了解成都地区医院抗高血压药的应用情况。方法:对成都地区17家医院抗高血压药的种类、销售金额、用药频度(DDDs)及日均费用等进行回顾性分析。结果:该地区医院抗高血压药的销售金额和DDDs逐年上升,销售金额排序列前10位的以钙拮抗药、血管紧张素受体Ⅱ抑制剂(ARB)、血管紧张素转换酶抑制剂(ACEI)为主。3年中,销售金额排序列第1位的均为氨氯地平;DDDs排序列前3位的药品有所变化,2009分别是氨氯地平、普萘洛尔、非洛地平。结论:成都地区医院抗高血压药以钙拮抗药、ARB和ACEI为主,钙拮抗药的销售金额占据了抗高血压药总销售额的近50%,ARB有望成为今后高血压的主要治疗药物。     

社区医院抗高血压药物使用情况调查

目的探讨基层社区医院抗高血压药物用药特点,为社区医院治疗高血压病提供参考。方法收集我市四家社区医院400例患者抗高血压药物的用药情况,调查降压药物的使用情况以及副作用发生情况。结果社区医院高血压病患者应用最多的是钙离子拮抗药,β受体阻滞药使用最少。结论基层医院应增加血管紧张素转换酶抑制药(ACEI)、血管紧张素受体拮抗药(ARB)、利尿药等的应用,社区医院作为高血压病预防和治疗工作的中心应权衡新旧药物的利弊,并注意社区医院临床医师的知识更新,给予患者科学有效的治疗方案。     

伊贝沙坦治疗原发性高血压疗效评价

目的：介绍血管紧张肽Ⅱ受体拮抗药伊贝沙坦治疗原发性高血压的降压疗效及临床应用前景。方法：与其他抗高血压药物钙拮抗药、血管紧张肽转换酶抑制药、β 受体阻滞药及同类药物相比。结果：伊贝沙坦降压平稳，与其他首选抗高血压药物疗效相同。结论：伊贝沙坦对轻、中度原发性高血压降压疗效确切，作用持久，耐受性好，不良反应发生率低，安全性好，是具有较好应用前景的抗高血压药。     

2004-2007年我院抗高血压药物的经济学分析

目的评价医院抗高血压药的利用情况及趋势。方法对该院2004-2007年口服抗高血压药的用药频度(DDDs)、销售金额等进行统计、分析。结果抗高血压药的销售金额均呈上升趋势,钙拮抗药和血管紧张素转换酶抑制剂均排在前2位。结论钙拮抗药和血管紧张素转换酶抑制剂最常用,体现了有效性、安全性和多样性等特点。     

Efficacy and Tolerability of Amlodipine in the General Practice Treatment of Essential Hypertension in an Asian Multinational Population

OBJECTIVE: To evaluate the efficacy and tolerability of once-daily amlodipine (Pfizer Pharmaceuticals Inc.) alone or in combination with other antihypertensive drugs in an Asian population with essential hypertension. PATIENTS: An open study was undertaken in 165 male and 158 female patients with uncomplicated hypertension (diastolic blood pressure 95 to 115mm Hg). Patients were recruited from 41 general practices in seven Asian countries and received amlodipine 5mg daily for 4 weeks and then 10mg once daily for a further 4 weeks if the target diastolic blood pressure of /=10mm Hg had not been achieved. This one-step dose-adjustment period was followed by a 4-week maintenance period on a constant dose. Amlodipine was the sole medication in 284 patients and was added to other antihypertensive drugs in 39 patients uncontrolled on previous medication. RESULTS: 263 patients, including 131 males, were evaluated for efficacy at the final treatment visit. 166 (63%) patients achieved the target reduction in diastolic blood pressure with amlodipine 5mg once daily, while 84 patients achieved the target reduction with 10mg once daily. Systolic and diastolic blood pressure reductions were similar irrespective of gender or age, and there were no significant changes in resting heart rate in any subgroup. In 68 patients who underwent ambulatory monitoring, the systolic and diastolic blood pressures were reduced by once-daily amlodipine throughout the 24-hour period without change in the intrinsic circadian pattern. Amlodipine was well tolerated in all patient subgroups; adverse events accounted for less than 1% of treatment discontinuations, and there were no hospitalisations or deaths during the study. Investigators rated both the antihypertensive efficacy and tolerability of amlodipine as excellent or good in 93% of patients. CONCLUSION: In 263 Asian patients with uncomplicated essential hypertension treated in general practice, once-daily amlodipine in a dose of 5 or 10mg provided significant antihypertensive efficacy either as monotherapy or in combination with other antihypertensive drugs while maintaining a favourable tolerability profile regardless of gender or age.     

Antihypertensive effects and pharmacokinetics of single and consecutive administration of doxazosin in patients with mild to moderate essential hypertension

A single dose of doxazosin, a long-acting postsynaptic alpha 1-adrenoceptor antagonist, was administered to seven patients with essential hypertension. Following administration of a single dose, all the patients except one who was forced to be discharged from the hospital for work, continuously received doxazosin once daily (o.d.) for evaluation of its consecutive dosing effect. The antihypertensive effect, pharmacokinetics, and effects on the plasma renin activity (PRA) of doxazosin were investigated. Following a 2-mg single dose of doxazosin, the systolic blood pressure (SBP) decreased significantly up to 12 h, whereas consecutive dosing produced a significant decrease in the SBP up to 24 h and a significant decrease in the mean blood pressure up to 24 h as compared with placebo. The pharmacokinetic parameters of doxazosin in both single- and consecutive-dose study were 18.9 and 25.8 ng/ml in Cmax, 11.1 and 12.9 h in half life (t1/2), and 182.0 and 273.0 ng h/ml in area under the curve (AUC)24(0), respectively. No significant changes were observed in PRA and plasma concentration of catecholamines. Neither were there any observable changes in endogenous creatinine clearance and in the urinary excretion rates of Na, K, and Cl. Doxazosin was well tolerated by all patients, and no untoward effects were observed. Doxazosin effectively reduces blood pressure and, because of its long t1/2 and minimal effects on PRA catecholamines, and electrolytes, seems to be a useful antihypertensive agent in patients with essential hypertension.     

Felodipine. A review of the pharmacology and therapeutic use of the extended release formulation in cardiovascular disorders.

Felodipine is a vascular-selective, dihydropyridine calcium antagonist previously investigated as a conventional tablet formulation administered twice daily. More recently considerable experience has been gained with an extended release (ER) formulation which has the convenience of once daily administration. Felodipine ER has been well studied in patients with essential hypertension. As monotherapy in mild to moderate essential hypertension, felodipine ER is at least as effective in reducing blood pressure as other calcium antagonists, beta-blockers, diuretics and ACE inhibitors, with some results favouring felodipine ER at a statistically significant level at the dosages used. It is also effective combined with controlled release metoprolol or enalapril in patients with mild to moderate essential hypertension. In patients with more severe forms of essential hypertension uncontrolled by beta-blocker and/or diuretic therapy, felodipine ER was effective as an 'add-on' therapy in placebo-controlled trials, and, at the dosages used, more effective than either sustained release nifedipine or nitrendipine. Felodipine produces effective control of blood pressure without negative effects on cardiac performance. In addition to its antihypertensive action, results suggest that felodipine therapy is associated with significant regression of left ventricular hypertrophy. Furthermore, it appears suitable for use in patients with concomitant diabetes, renal dysfunction or asthma, and is also being investigated for use in patients with congestive heart failure or angina pectoris. Felodipine ER is an effective drug for the treatment of all grades of essential hypertension, and can be used both as monotherapy and in combination with other antihypertensive agents. Further clinical experience should fully establish the long term tolerability of felodipine ER and consequently its place in therapy relative to other accepted antihypertensive drugs. However, with the convenience of once daily administration, felodipine ER is a worthwhile innovation in the treatment of hypertension.     

Valsartan plus hydrochlorothiazide: a review of its use since its introduction

INTRODUCTION: This review focuses on the role of the fixed-dose combination (FDC) drug valsartan/hydrochlorothiazide (HCTZ) in the treatment of hypertension. Effective blood pressure control often is not achieved with monotherapy and, instead, requires combinations of drugs with different mechanisms of action to produce additive or synergistic effects. AREAS COVERED: FDC valsartan/HCTZ enhances not only efficacy for blood pressure control but also provides beneficial effects on target organs beyond that expected from arterial pressure reduction alone. Data describe key clinical trial experiences with the FDC, with particular attention to efficacy and tolerability. Literature searches of these various topics were conducted in January 2011. There is evidence of potential benefits with this combination associated with left ventricular hypertrophy, left ventricular dysfunction and renal disease. The FDC is an effective treatment for patients with hypertension and is superior to monotherapy than either drug alone. EXPERT OPINION: In addition to the benefits of each drug, valsartan/HCTZ's metabolic interactions reduce some of the negative effects of both compounds. With its increased simplicity, minimal side-effect profile and efficacy without a significant cost penalty, valsartan/HCTZ represents an excellent choice for antihypertensive therapy.     

The pharmacokinetics and pharmacodynamics of doxazosin compared with atenolol during long-term double-blind treatment

Summary The pharmacodynamics of doxazosin and atenolol were compared on single study days in 39 patients with mild to moderate hypertension receiving long-term double-blind treatment. The pharmacokinetics of doxazosin were investigated in the 20 patients receiving doxazosin. Individually titrated once daily doses of doxazosin were 1, 2, 4, 8 or 16 mg and of atenolol 50 or 100 mg. Patients were first investigated after at least one month on constant dose and then again after at least a further three months. Mean plasma concentrations of doxazosin were proportional to dose and the plasma half-life was 11.5 h and independent of dose. There was low variability of doxazosin plasma concentrations between patients receiving the same dose. Concentrations and half-life were unchanged during the period between investigations. Mean reductions of AUC (0–12 h) blood pressure during the 12-h period post-dose and of blood pressure at 24 h post-dose were not statistically different between doxazosin and atenolol. There was effective control of blood pressure by both drugs at all time points of the day. The pharmacokinetic and pharmacodynamic results obtained in this study are compatible with the use of doxazosin in a once daily dose regimen for the treatment of essential hypertension.     

Telmisartan: a review of its use in the management of hypertension

Telmisartan (Micardis, Pritor), a highly selective angiotensin II (AII) type 1 (AT1) receptor antagonist, is approved for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. The long elimination half-life of telmisartan ensures the drug provides effective reductions in blood pressure (BP) across the entire 24-hour dosage interval. Extensive evidence from well designed clinical trials and the clinical practice setting indicates that telmisartan, either as monotherapy or in combination with other antihypertensive agents, provides long-term antihypertensive efficacy and is well tolerated in a broad spectrum of hypertensive patients, including the elderly and those with coexisting type 2 diabetes mellitus, metabolic syndrome and/or renal impairment. Notably, BP control is sustained throughout the 24-hour dosage interval, including during the last 6 hours of this period. Independent of its effect on BP, telmisartan displays favourable effects on insulin resistance, lipid levels, left ventricular hypertrophy (LVH) and renal function. The consistent antihypertensive efficacy during the entire 24-hour dosage interval and sustained BP-lowering effect in the long term, combined with its favourable tolerability profile, mean that telmisartan is a valuable first-line treatment option for the management of essential hypertension.     

Felodipine. A review of the pharmacology and therapeutic use of the extended release formulation in older patients.

Felodipine is a dihydropyridine calcium antagonist which may be administered once daily in an extended release (ER) formulation. As monotherapy in older patients with mild to moderate essential hypertension, felodipine ER once daily provides effective control of blood pressure (BP). The drug has also been effective, either as monotherapy or in combination with other antihypertensive medications, in comparisons with other antihypertensive agents, and does not adversely affect lipid profiles or, in patients with diabetes mellitus, glycaemic control. Results in patients with angina pectoris and congestive heart failure indicate a potential role for felodipine ER in these indications and data also suggest the drug reduces left ventricular hypertrophy. In addition, felodipine ER appears suitable for use in patients with concomitant respiratory disease, renal or hepatic dysfunction, cerebrovascular or peripheral ischaemic disease, or gout, making it particularly useful in the elderly who often have more than one significant clinical condition. Felodipine ER has generally been well tolerated by older patients in clinical trials, although further confirmation in the long term is desirable. Thus, felodipine ER effectively lowers BP in older patients with essential hypertension with the added convenience of once daily administration. It may be used as monotherapy or in combination with other antihypertensive agents and is a practical advance in the treatment of hypertension in the elderly.     

轻、中度高血压病病人口服多沙唑嗪控释片与贝那普利比较

目的 :评价多沙唑嗪控释片对轻、中度高血压病病人降压有效性及安全性。方法 :采用双盲、双模拟、随机化、平行对照研究方法。 5 8例服多沙唑嗪控释片 4mg ,poqd× 8wk ,5 6例服贝那普利 10mg ,poqd× 8wk。此外 ,对 3 3例开放服多沙唑嗪控释片 4mg ,qd× 8wk。服药前后行 2 4h动态血压监测 (2 4hABPM)。结果 :2组均能有效地降压 ,有效率分别为 81%及 77% (P >0 .0 5 )。多沙唑嗪组不良反应明显少于贝那普利组 (3 %及 2 0 % ) ,P <0 .0 1,无体位性低血压及反射性心动过速。 2 4hABPM示等幅度降日间血压及夜间血压。谷 /峰比值 :SBP为 0 .69,DBP为 0 .5 9。结论 :多沙唑嗪控释片是一种有效安全的长效肾上腺素α1受体阻滞剂。     

Prescribing pattern of antihypertensive drugs in primary care units in Turkey: results from the TURKSAHA study

OBJECTIVES: The prescribing pattern of drugs used for treating hypertension changes over time in response to changes in recommended guidelines and innovations in drug formulations, among others. In addition, the classes of antihypertensive drugs used vary among the countries. The aim of this study was to investigate the practice of antihypertensive medications in primary care units in Turkey. METHOD: TURKSAHA is a cross-sectional screening study conducted in 1000 primary care units considered to be representative of primary care in Turkey, with the purpose of defining the demographic characteristics, clinical features, rate of blood pressure control achieved and the antihypertensive drugs prescribed for the hypertensive patients treated in these centers. In this analysis, we investigated the agents used in the treatment regimen. RESULTS: Of the 16,270 patients considered to be eligible for inclusion in the study, 15,187 (93.3%) were on an antihypertensive treatment, and 1083 (6.7%) were receiving no treatment. Patients who received treatment but whose antihypertensive medication was not specified (2290 patients) were subsequently excluded, and the trial was carried out with the remaining 12,897 patients. The mean age of the patients was 60 +/- 11 years (60.2% female). Of the 12,897 patients, 75.7% were receiving monotherapy, 19.7% two drugs, 4.1% three drugs and 0.5% four or more drugs. The rate of successful blood pressure control (<140/90 mmHg; for diabetics <130/80 mm Hg) in relation to the number of drugs received was 26.3, 25.9, 24.5 and 26.2%, respectively. Among the patients receiving monotherapy, the most frequently used antihypertensive drug class was angiotensin-converting enzyme inhibitors (30.1%), followed by beta-blockers (20.6%), calcium-channel blockers (17.9%), diuretics (15.4%) and angiotensin-receptor blockers (14%). CONCLUSION: As in other European countries, the rate of successful blood pressure control was low among hypertensive patients receiving treatment, and despite the inadequacy of monotherapy to control blood pressure, many of the patients continued this treatment regimen. Consistent with the global trend, the most frequently prescribed anti-hypertensives were angiotensin blockers.     

The Choice of Antihypertensive Drugs in Patients with Erectile Dysfunction

Summary

It is well established that hypertension and the more traditional anti-hypertensive drugs are associated with erectile dysfunction (ED). There is evidence showing that two antihypertensive drugs - doxazosin and losartan - have a positive effect on erectile function. Therefore these drugs may decrease the incidence of ED in patients who need treatment for hypertension. Doxazosin

and/or losartan can also be beneficial in patients who develop ED after starting treatment with other antihypertensive drugs. These options could, in turn, ensure better compliance and blood pressure control. A fall in the overall cost of treatment will also be anticipated if there is a reduced need for drugs prescribed for ED in patients with hypertension.