降压药临床应用进展

阐述常用的5种降压药物,包括利尿剂、钙离子拮抗剂、β肾上腺素受体阻滞剂、血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体阻滞剂的药物特点,并且着重介绍这5种降压药物联合应用时产生的相互作用和临床疗效。     

我院门诊高血压药物应用合理性分析

目的分析医院门诊高血压药物应用的合理性。方法选取2018年7-12月句容市边城卫生院符合条件的门诊降压药物处方2500张并进行统计分析。结果医院门诊常用6大类降压药物中钙通道阻滞剂(CCB)、血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体阻滞剂(ARB)使用频率高;在门诊降压药物使用过程中,联合2种降压药物741张(29.64%);3种降压药物联合使用394张(15.76%);CCB与其他药物联合使用856张(34.24%)。结论医院门诊降压药物的使用基本合理,通过本研究统计分析,对门诊高血压患者安全、有效地使用降压药物起到积极作用。     

降压药物ACEI和CCB的联合应用

血管紧张素转换酶抑制剂(ACEI)和钙通道阻滞剂或钙离子拮抗剂(CCB)联合应用临床上应用最广泛,效果可靠。此两种药物联合时降压效力相加或加强,在应用较小剂量即不引起血压下降的剂量时也出现降压反应,值得临床推广应用。     

血管紧张素转换酶抑制剂同其它药物的相互作用

本文节译血管紧张素转换酶抑制剂与利尿剂、β－阻滞剂、钙拮抗剂、地高辛和基血管扩张剂等药物合用时，药代动力学方面所产生的相互作用，为指导临床联合用药提供依据。     

门诊口服抗高血压药合理应用分析

目的：通过对门诊口服抗高血压药应用情况,为临床合理治疗高血压提供依据。方法回顾性分析我院2010年9月～2011年9月门诊开出的抗高血压药物的4728例处方,对其药物种类、药物剂量及用药情况进行统计分析。结果我院常用降压药物使用频率从高到低的依次是钙拮抗剂、血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、血管紧张素转化酶抑制剂及利尿剂。结论我院门诊在降压药物应用基本合理,无滥用药物现象,门诊在联合用药多于单一用药,对于药物之间的相互作用应加强监护。     

高血压引起的主动脉夹层患者60例用药分析

目的 了解主动脉夹层(AD)患者降压药物使用情况.方法 选择由高血压引起的AD患者60例,对其降压药物使用情况及血压、心率达标情况进行统计分析.结果 入院时为尽快达到目标血压,首选硝普钠静脉用药联合多种口服降压药物;口服降压药物使用率排列:β受体阻滞剂>钙离子拮抗剂(CCB)>血管紧张素受体拮抗剂(ARB)>血管紧张素转换酶抑制剂(ACEI)≥α受体阻滞剂>利尿剂;出院用药仍为多种降压药物联合使用;患者出院时血压、心率达标率显著高于入院时,差异有统计学意义(P<0.01).结论 高血压引起的AD患者降压药物使用特点为强效、多药联合,有效缓解了病情,但临床药师仍应加强药物不良反应监测、出院教育及随访工作.     

2011—2013年我院口服降压药物应用分析

<正>目前降压药物类型基本分为利尿剂、β受体阻滞剂(β-RB)、钙通道阻滞剂(CCB)、血管紧张素转换酶抑制剂(ACEI)以及血管紧张素Ⅱ受体拮抗剂(ARB)五类,目前如何合理应用抗高血压药物,稳定患者血压,减少心脑血管疾病及其并发症的发生,提高患者的生活质量,减轻患者和社会的经济负担,成为医药工作者关注和研究的课题。本文就我院     

878例老年高血压病住院患者使用降血压药物状况分析

目的：分析老年高血压患者降压达标时的用药状况及临床意义。方法：对住院的878例老年高血压病患者在血压降至达标时所用降压药的情况及疗效进行分析。结果：联合药物治疗的例数510例（占总例数58.09%）,明显高于单一药物治疗的例数368例（41.91%）;两种药物联合应用的例数304例（34.62%）,明显高于三种药物联用的例数168例（19.13%）;四种及五种药物联合应用的例数分别为32例（3.64%）和6例（0.68%）,差异均有显著性意义,P〈0.05。结论：老年高血压病患者降压达标大多需联合用药;较好的联合用药方案为钙通道阻滞剂（CCB）＋血管紧张素转换酶抑制剂（ACEI）或血管紧张素Ⅱ受体阻滞剂（ARB）或β受体阻滞剂（β-RB）,和CCB＋ACEI或ARB或β-RB＋利尿剂（DA）。     

高血压引起的主动脉夹层患者60例用药分析

目的了解主动脉夹层(AD)患者降压药物使用情况。方法选择由高血压引起的AD患者60例,对其降压药物使用情况及血压、心率达标情况进行统计分析。结果入院时为尽快达到目标血压,首选硝普钠静脉用药联合多种口服降压药物;口服降压药物使用率排列:β受体阻滞剂>钙离子拮抗剂(CCB)>血管紧张素受体拮抗剂(ARB)>血管紧张素转换酶抑制剂(ACEI)≥α受体阻滞剂>利尿剂;出院用药仍为多种降压药物联合使用;患者出院时血压、心率达标率显著高于入院时,差异有统计学意义(P<0.01)。结论高血压引起的AD患者降压药物使用特点为强效、多药联合,有效缓解了病情,但临床药师仍应加强药物不良反应监测、出院教育及随访工作。     

ACEI与其他治疗高血压药物联用的相互作用

高血压是一种常见的心血管疾病,以动脉血压增高为主要临床表现。根据高血压药物治疗"阶梯疗法,联合用药"的基本原则,查阅国内外文献结合临床用药习惯,笔者对血管紧张素转换酶抑制剂(ACEI)在治疗高血压过程中与其他降压药物在联合用药时可能产生的相互作用进行分析,旨在探讨其联合用药的利弊,为临床安全、有效用药提供参考。     

Drug interactions with angiotensin receptor blockers

Many patients with high blood pressure receive multiple medications for hypertension and other conditions, placing them at risk for adverse drug interactions. Additionally, as the prevalence of hypertension increases with age, factors like greater frailty, comorbidity of the elderly requiring polypharmacy, and reduced hepatic and renal clearance rates for the elimination of drugs increase the likelihood of drug interactions. Angiotensin receptor blockers (ARBs) are the most recent class of agents for the treatment of hypertension. Due to a favourable side effect profile, this class of drugs deserves increased attention. This article reviews drug interactions of ARBs and suggests measures for reducing the risk of adverse events when drugs are co-administered. MEDLINE, EMBASE, Cochrane library, and CINAHL were searched. Reported and likely clinical relevant interactions of ARBs with concomitantly given drugs are summarised in Table 2 and 3. Compared to other classes of antihypertensive agents, the ARBs appear to have a low potential for drug interactions; however, interactions with this class occur and variations within the class have been detected, mainly due to different affinities for cytochrome P450 isoenzymes.     

Antihypertensive therapy: special focus on drug interactions

Today, the lifetime risk of patients aged 55 – 65 years to receive antihypertensive drugs approaches 60%. Yet, recent trials suggest that hypertension is not adequately controlled in the majority of patients. The prevalence of hypertension increases with advancing age, as does the prevalence of comorbid conditions and the total number of medications taken. Multi-drug therapy, advancing age and comorbid conditions are also key risk factors for adverse drug reactions and drug interactions. In this review, the authors evaluate the most frequently used antihypertensive drugs (diuretics, β-adrenergic blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor Type 1 blockers and α-adrenergic blockers) with special reference to pharmacodynamic and pharmacokinetic drug interactions. As the spectrum of drugs prescribed is constantly changing, safety yesterday does not imply safety today and safety today does not imply safety tomorrow. Furthermore, therapeutic efficacy should not be neglected over concerns regarding drug interactions. Many patients are at risk of clinically relevant drug interactions involving antihypertensive drugs but, presently, even more patients may be at risk of suffering from the consequences of their inadequately treated hypertension. In this respect, the authors discuss controversial viewpoints on the overall clinical relevance of drug interactions occurring at the level of cytochrome P450 metabolism.     

A practical guide to the management of hypertension in renal transplant recipients

Hypertension as well as hypotension can be harmful to a newly transplanted renal allograft. Elevated blood pressure is also a major risk factor for cardiovascular death, which is a frequent occurrence despite successful renal transplantation. Renal artery stenosis, immunosuppressive drugs, chronic rejection, retained native kidneys, and excessive extracellular fluid volume may all contribute to post-transplant hypertension. Antihypertensive agents are widely used in the management of post-transplant hypertension. Careful clinical judgement and knowledge of the pharmacology, pharmacodynamics, pharmacokinetics, adverse drug reaction profiles, potential contraindications, and drug-drug interactions of antihypertensive agents are important when therapy with antihypertensive drugs is initiated in renal transplant recipients. Since blood pressure elevation in any individual is determined by a large number of hormonal and neuronal systems, the effect of antihypertensive agents on the allograft should be considered a critical factor in the management of hypertension in renal transplant recipients. Most renal transplant recipients have other risk factors for premature cardiovascular death such as diabetes mellitus, hypercholesterolemia, insulin resistance, obesity, left ventricular hypertrophy and ischaemic heart disease. Initial antihypertensive therapy should be tailored individually according to the patient's risk factors. A realistic therapeutic goal for blood pressure management in the initial post-operative state is a systolic blood pressure <160 mm Hg and a diastolic blood pressure <90 mm Hg with lower pressure targets becoming applicable late post-transplantation.     

原发性高血压患者相关药学知识调查及不良服药行为的因素分析

目的调查原发性高血压患者药学知识,为临床用药指导确定内容和方向;探讨患者不良服药行为的相关因素,提出干预措施。方法采用当面询问及填写问卷相结合的方法,对高血压患者的一般情况、药学知识以及不良服药行为内容及进行调查、统计和分析。结果在被调查的154例患者中,85.71%觉得对所服用的抗高血压药品知识缺乏了解,其中缺乏抗高血压药的作用机制、药理作用最多,达76.62%,62.99%的患者存在不良服药行为。讨论原发性高血压患者对所服用的抗高血压药物的知识缺乏,患者的依从性低,出现较多的不良服药行为,要求医务人员及药学工作者积极开展药学服务工作,根据患者情况提供有针对性的用药指导,提高患者的用药依从性,提高药物治疗效果。     

重庆市江津区老年高血压患者降压药物使用情况的调查分析

目的：为促进老年高血压患者合理用药提供参考。方法：自拟调查问卷,对重庆市江津区几江镇、广兴镇、永兴镇的5个社区的部分老年高血压患者进行调查,了解其降压药物使用情况及存在问题,并分析原因。结果：共设15个调查点,发放问卷2968份,回收有效问卷2543张,有效回收率为85．7％。调查发现,受访者文化水平及经济收入低,对疾病重视程度及相关知识知晓率低,且缺少规律的专业性用药指导,导致降压药使用后不良反应发生率高（46．7％）,高血压控制率低（5．4％）,用药不合理比例高（75．5％）。结论：老年高血压患者药物治疗存在较多问题,社区高血压防治工作亟待加强。建议完善社会医疗保障体系,提高基层医疗单位医务人员的知识水平,提高基层患者群防治意识,扩大治疗覆盖面,以促进老年患者合理使用降压药物。     

Antihypertensive therapy: special focus on drug interactions

Today, the lifetime risk of patients aged 55-65 years to receive antihypertensive drugs approaches 60%. Yet, recent trials suggest that hypertension is not adequately controlled in the majority of patients. The prevalence of hypertension increases with advancing age, as does the prevalence of comorbid conditions and the total number of medications taken. Multi-drug therapy, advancing age and comorbid conditions are also key risk factors for adverse drug reactions and drug interactions. In this review, the authors evaluate the most frequently used antihypertensive drugs (diuretics, beta-adrenergic blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor Type 1 blockers and alpha-adrenergic blockers) with special reference to pharmacodynamic and pharmacokinetic drug interactions. As the spectrum of drugs prescribed is constantly changing, safety yesterday does not imply safety today and safety today does not imply safety tomorrow. Furthermore, therapeutic efficacy should not be neglected over concerns regarding drug interactions. Many patients are at risk of clinically relevant drug interactions involving antihypertensive drugs but, presently, even more patients may be at risk of suffering from the consequences of their inadequately treated hypertension. In this respect, the authors discuss controversial viewpoints on the overall clinical relevance of drug interactions occurring at the level of cytochrome P450 metabolism.     

探讨中国、美国及欧洲高血压防治指南中有关药物治疗的问题

高血压治疗,药物的选择是关键,我国临床应用的降压药物种类,包括中西药及各种复方制剂有几百种之多,但我国高血压的治疗率和控制率都很低,高血压防治形势不容乐观。本文对中国、美国及欧洲高血压防治指南中有关药物治疗方面的差异进行比较,并对高血压药物临床选择的原则进行探讨。中、美、欧指南均认为不同类别的降压药物在某些治疗效果或特殊的人群中确实存在差异,因此对特定的强制性适应症应采用特定类别的降压药物。三个指南都强调合并用药的益处,并建议采用能维持24 h的长效药物或制剂。但三个指南在是否推荐一线治疗药物上存在明显分歧,美国指南建议噻嗪类利尿剂可作为大多数无并发症高血压患者的首选药,而欧洲指南和中国指南均未推荐一线药物,认为几个主要类别的降压药均可用于高血压的起始治疗和维持治疗。中医药是我国特有的宝贵资源,各种降压中成药在临床上有广泛的应用,但由于缺乏高质量证据,2004年中国高血压防治指南中缺少中成药部分。临床上降压药物的选择首先取决于药物的疗效和安全性,在疗效与安全性相差不大的情况下,应优先选择相对价廉的药物。对于我国大多数高血压患者,如果没有必需使用其他药物的适应症,低剂量噻嗪类利尿药可以作为治疗的首选方案。2004年中国高血压防治指南的出台,对我国高血压防治工作具有重要的意义,现阶段应加强指南的推广和实施,促进临床高血压药物的合理使用,提高血压控制率。     

动脉粥样硬化性心血管疾病的药物治疗研究进展

动脉粥样硬化性心血管疾病（atherosclerotic cardiovascular disease,ASCVD）患病率的快速增长是国内心血管疾病的重要特征。尽管已知多个因素包括家族遗传、生活方式和饮食习惯等与ASCVD的病理过程相关,但其发病机制尚不明确。目前临床对ASCVD的传统干预手段是以低密度脂蛋白胆固醇（low-density lipoprotein cholesterol,LDL-C）为靶标的降脂药物治疗。近年来,前蛋白转化酶枯草溶菌素9（proprotein convertase subtilisin/kexin type 9,PCSK9）单抗等药物的出现使降脂治疗焕发新的“生机”。一些抗炎药物在临床试验中显著降低ASCVD患者心血管事件发生的风险,亦展现出了极大的开发潜力。此外,越来越多的研究从表观遗传的角度来阐明ASCVD的发病机制,发掘出了许多治疗靶点。综述这些药物以及相关靶点的研究进展,为未来的ASCVD临床药物治疗探索方向。