坎地沙坦酯联合小剂量双氢克尿噻治疗老年高血压的临床疗效观察

目的 探讨坎地沙坦酯联合小剂量双氢克尿噻治疗老年高血压的临床疗效.方法 选取在我院接受治疗的老年高血压患者共86例,将其随机分为对照组和研究组,各43例.对照组单纯给予坎地沙坦酯进行治疗,研究组采用坎地沙坦酯联合小剂量双氢克尿噻进行治疗.结果 治疗后,两组患者的收缩压和舒张压比较,差异有统计学意义(P＜0.05).研究组的疗效优于对照组,差异有统计学意义(P＜0.05).结论 坎地沙坦酯联合小剂量双氢克尿噻治疗老年高血压,疗效显著,值得在临床推广应用.     

氯沙坦及氯沙坦与双氢克尿噻合剂对原发性高血压患者肾素活性影响的比较

目的比较血管紧张素Ⅱ受体拮抗剂氯沙坦及氯沙坦与双氢克尿噻合剂对原发性高血压患者的降压疗效和肾素活性水平的影响。 方法坐位舒张压95～115mmHg(1mmHg=0.133kPa)的76例原发性高血压患者,经1周药物洗脱期,2周安慰剂期后,随机服用氯沙坦50mg(氯沙坦组,n=37),每日1次或氯沙坦50mg与双氢克尿噻12.5mg合剂(氯沙坦+双氢克尿噻合剂组,n=39),每日1次。4周末坐位舒张压≥90mmHg者,剂量分别加倍,继续服用4周。于安慰剂期末及服药8周末测量诊室坐位血压和测定立位血浆肾素活性水平。 结果服药8周末平均坐位舒张压氯沙坦组(n=35)下降10.1±9.1mmHg;氯沙坦+双氢克尿噻合剂组(n=33)下降14.6±7.5mmHg(组间比较P＜0.05);同时服用末次药24小时后氯沙坦组的平均血浆肾素活性从1.6ng/(ml*h)增加至5.4ng/(ml     

替咪沙坦与纈沙坦降压疗效的对比观察

替咪沙坦系血管紧张素Ⅱ受体拮抗剂 ,其降压疗效目前国内报道尚少 ,我们于 2 0 0 2年 10月至 2 0 0 3年 3年通过替咪沙坦或纈沙坦治疗高血压患者 8周 ,以对比其降压疗效。　　一、对象与方法　　 1.对象 :根据 1999年WHO/TSH的高血压诊断标准 ,选择 6 0例轻、中度高血压患者 ,男 32例 ,女 2 8例 ,年龄 6 0～ 78岁 ,平均 6 5 5岁 ,经病史、体检、血尿常规、生化、ECG、胸部X线、腹部多普勒超声检查 ,排除继发性高血压及其他器质性心脏病及肾功能异常。　　 2 .方法 :患者先停服降压药 1周 ,于 1周末测 2 4h动态血压 ,若白昼平均血压 >14…     

坎地沙坦对动脉粥样硬化大鼠抗氧化作用的实验研究

目的探讨坎地沙坦对动脉粥样硬化（AS）大鼠抗氧化作用的影响。方法将50只SD大鼠随机分为对照组、模型组、坎地沙坦高剂量组、坎地沙坦中剂量组、坎地沙坦低剂量组。模型组、坎地沙坦高剂量组、坎地沙坦中剂量组、坎地沙坦低剂量组均为AS大鼠模型。12周后腹腔静脉取血检测各组血脂、丙二醛（MDA）、超氧化物歧化酶（SOD）指标。结果与模型组相比,坎地沙坦低、中、高剂量组均可以降低血脂水平（P〈0.05）,但无剂量依赖性;坎地沙坦高剂量组MDA水平下降（P〈0.01）、SOD水平增高（P〈0.05）。结论高剂量坎地沙坦抗氧化作用显著。     

坎地沙坦与福辛普利对高血压疗效的观察

目的前瞻性评估坎地沙坦治疗原发性高血压的降压疗效和安全性。方法130例轻中度原发性高血压患者随机服用坎地沙坦4~8mg或福辛普利10~20mg共20周,服药前后行动态血压监测(ABPM),观察24h收缩压(SBP)和舒张压(DBP)、谷峰比值、下一次给药前6h血压变化、降压有效率和不良反应。结果坎地沙坦和福辛普利均能有效降低血压,20周治疗有效率分别为74%和73%(P>0.05),坎地沙坦谷峰比值较福辛普利高(SBP:79%VS63%,P<0.05;DBP:79%vs62%P<0.05;),且较福辛普利具有更强的减低清晨2:00~8:00血压的作用(P<0.05)。坎地沙坦不良反应发生率较少。结论坎地沙坦治疗轻中度原发性高血压安全有效,耐受性好,可持续24h理想的控制血压。     

奥美沙坦与坎地沙坦治疗轻、中度原发性高血压的疗效及安全性比较

目的 评价奥美沙坦24 h降压尤其是降低晨峰血压的效果.方法 120例轻、中度原发性高血压患者随机双盲服用奥美沙坦20 mg或坎地沙坦8 mg,共8周.服药前、服药后8周行动态血压监测(ABPM),比较两组24 h,白昼,下一次给药前4 h、2 h ABPM达标的患者比例.结果 8周后奥美沙坦和坎地沙坦均能有效降低血压,奥美沙坦治疗的24 h血压和白天血压达标率高于坎地沙坦,分别为37%比25%和25%比15%,在动态血压监测的最后2 h、4 h,血压的达标比例奥美沙坦高于坎地沙坦,分别为30%比20%和40%比25%.结论奥美沙坦治疗的高血压患者24 h血压和晨峰血压达标率比例高.奥美沙坦不仅能较好地控制24 h血压,而且能降低与晨峰血压高有关的心血管事件.     

小剂量双氢克尿噻对不同类型高血压疗效的对比研究

目的:观察小剂量双氢克尿噻对中老年(混合型)高血压、单纯收缩期高血压的疗效。方法:中老年高血压患者174例,其中81例为单纯收缩期高血压,93例为(混合型)高血压。服用双氢克尿噻前1日,停用一切降压药物.单用双氢克尿噻12.5mg,每日1次,早餐后顿服,疗程均为6周。每两周随访,观察血压、脉压差、心率、症状及有关副作用表现。结果:双氢克尿噻治疗6周后.中老年单纯收缩期高血压组收缩压非常显著下降(P<0.01),舒张压显著下降(P<0.05);(混合型)高血压治疗组收缩压、舒张压均在第2周非常显著下降(P<0.01),第4周、第6周无继续下降。脉压差单纯收缩期高血压治疗组降低非常明显(P<0.01)。混合性高血压组下降不明显(P>0.05)。结论:小剂量双氢克尿噻对中、老年(混合型)高血压、单纯收缩期高血压均有疗效,对单纯收缩期高压降压效果更显著.更为安全、有效。     

坎地沙坦与依那普利治疗高血压疗效及不良作用比较

目的比较坎地沙坦与依那普利治疗轻中度高血压的疗效和不良作用。方法随机开放对照试验72例轻中度高血压患者,分坎地沙坦组和依那普利组各36例,经5天导入期,进入8周治疗期。坎地沙坦4mg,1次/d,依那普利10mg,1次/d。2周后如血压下降未达到<140/90mmHg则剂量加倍,3周后仍未达到<140/90mmHg,则每日加服双氢克尿噻25mg。结果两组药物均能明显降低血压,坎地沙坦有效率88.8%,依那普利有效率86.1%,两组有效率无统计学意义。最常见的不良作用是咳嗽,坎地沙坦组1例(2.8%),依那普利组8例(22.2%),前者低于后者。结论坎地沙坦和依那普利对治疗轻中度高血压均获满意结果,且安全性好,坎地沙坦耐受性优于依那普利。     

坎地沙坦联合辛伐他汀治疗糖尿病肾病的临床疗效研究

选取本院近3年收治的126例DN患者,平分为对照组单用坎地沙坦治疗,联合组采用坎地沙坦联合辛伐他汀治疗。结果:联合组HbA_(1c)、TG、TC、LDL-C、ACR、RBP、NAG明显低于对照组,且HDL-C、GFR、总有效率明显高于对照组(P0.05)。两组均未出现严重不良反应。结论:联合治疗DN可有效改善患者肾功能,稳定血糖。     

Comparison of the antihypertensive efficacy of irbesartan/HCTZ and valsartan/HCTZ combination therapy: impact of age and gender

This analysis aimed to explore whether low-dose irbesartan/hydrochlorothiazide (HCTZ) has superior blood pressure (BP)-lowering efficacy over low-dose valsartan/HCTZ in the elderly and across both genders. This is a post-hoc analysis of data from a multicenter, parallel group, open-label, blinded-endpoint study in patients with hypertension uncontrolled with HCTZ monotherapy. The reduction in systolic BP (SBP)/diastolic BP (DBP) and rate of BP control achieved following 8 weeks of treatment with irbesartan/HCTZ 150/12.5 mg or valsartan/HCTZ 80/12.5 mg were analyzed for older (≥65 years) vs. younger (<65 years) patients and for men vs. women. Blood pressure measurements were by home BP monitoring (HBPM). In the age and gender subgroups, both treatments significantly decreased home SBP and DBP (p < 0.0001). The reduction in home SBP and DBP was numerically greater with irbesartan/HCTZ compared to valsartan/HCTZ for all subgroups: the difference in DBP was significant for all except the elderly (p < 0.05), and the difference in SBP was significant in the elderly and in men (p < 0.03). In all subgroups, more patients achieved BP control (HBPM ≤135/85 mmHg) in the irbesartan/HCTZ arm (range 45%-58%) than in the valsartan/HCTZ arm (range, 23%-39%; p < 0.02). Both combination therapies were well tolerated and safety parameters were similar in both age and gender subgroups. More patients with mild or moderate hypertension, uncontrolled in HCTZ monotherapy alone, had their BP controlled with irbesartan/HCTZ 150/12.5 mg than with valsartan/HCTZ 80/12.5 mg, irrespective of age or gender.     

Losartan titration versus diuretic combination in type 2 diabetic patients

METHODS: We compared the effects of Losartan dose titration to 100 mg versus the addition of 12.5 mg of hydrochlorothiazide, in 90 type 2 diabetic patients with microalbuminuria and blood pressure > 130/85 mmHg, receiving losartan 50 mg as initial treatment during 4 weeks. RESULTS: With the first dose of losartan, systolic (SBP) and diastolic blood pressure (DBP) decreased from 154.5 (152.1-157.5) to 144.4 (141.3-147.5) mmHg (P < 0.001) and from 91.1 (89.4-92.8) to 84.6 (82.8-86.4) mmHg (P < 0.001), with 20 patients attaining the expected goal blood pressure (< 130/85 mmHg); albuminuria decreased from 109.8 (90.5-133.3) to 83.5 (63.6-109.5) mg per 24 h (P = 0.006). Patients not attaining the target blood pressure were randomly allocated to titration or to the combination arm. After an additional 4 weeks, patients titrated exhibited a fall in SBP and DBP from 157.1 (152.7-161.5) to 142.1 (136.4-147.8) mmHg (P < 0.001) and from 92.4 (89.5-95.3) to 83.6 (81.1-86.1) mmHg (P < 0.001); albuminuria decreased from 136.3 (97.8-189.9) to 99.7 (69.3-143.4) mg per 24 h (P = 0.002). In the combination arm, there were similar reductions in SBP and DBP from 155.3 (151.5-159.1) to 139.1 (132.1-146.1) mmHg (P < 0.001) and from 92.1 (89.3-94.9) to 80.9 (77.4-84.4) mmHg (P < 0.001); while albuminuria fell from 107.7 (82.2-141.0) to 64.2 (45.9-89.9) mg per 24 h (P = 0.001). CONCLUSIONS: Losartan 50 mg was effective in reducing blood pressure and albuminuria in type 2 diabetic patients. When the blood pressure target was not reached, the two strategies tested seem to contribute similarly to further reductions in blood pressure and albuminuria.     

A comparison of the efficacy and safety of irbesartan/HCTZ combination therapy with irbesartan and HCTZ monotherapy in the treatment of moderate hypertension

This prospective, double-blind, parallel-group study randomized patients with moderate hypertension (seated systolic blood pressure (SeSBP) 160-179 mm Hg when seated diastolic blood pressure (SeDBP) <110 mm Hg; or SeDBP 100-109 mm Hg when SeSBP <180 mm Hg) 3:1:1 to treatment with irbesartan 300 mg/hydrochlorothiazide (HCTZ) 25 mg combination therapy (n=328), irbesartan 300 mg monotherapy (n=106) or HCTZ monotherapy 25 mg (n=104). Treatment was initiated at half dose, with forced titration to full dose after two weeks followed by ten further weeks' treatment. The primary efficacy variable was the mean reduction in SeSBP from baseline to week 8. Baseline characteristics were similar between groups, with mean baseline blood pressure approximately 162/98 mm Hg; the mean age was 55 years. At week 8 there was a reduction in SeSBP of 27.1 mm Hg with irbesartan/HCTZ, compared with 22.1 mm Hg with irbesartan monotherapy (P=0.0016) and 15.7 mm Hg with HCTZ (P<0.0001). Both the rate of decline and the total degree of decline achieved were greatest with irbesartan/HCTZ and least with HCTZ. A significantly greater percentage of patients reached a treatment goal of SeSBP <140 mm Hg and SeDBP <90 mm Hg by week 8 with irbesartan/HCTZ (53.4%), compared with irbesartan (40.6%; P=0.0254) and HCTZ (20.2%; P<0.0001) alone. Treatment was well tolerated in all three-treatment groups with a slight increase in adverse events in the combination therapy group. In conclusion, irbesartan/HCTZ (300/25 mg) is well tolerated and achieves rapid and sustained reductions in both systolic blood pressure and diastolic blood pressure in patients with moderate hypertension.     

Losartan versus enalapril on cerebral edema and proteinuria in stroke-prone hypertensive rats

Stroke-prone spontaneously hypertensive rats (SHRSP), subjected to high NaCl, show severe hypertension, organ damage, and early death. Preventive treatment with angiotensin II type 1 (AT1) receptor antagonists is known to be effective. Previously, we found that angiotensin converting enzyme (ACE) inhibition could reduce cerebral edema when treatment was started after manifestation of either proteinuria or cerebral edema. In this study AT1 receptor blockade was started at the same time points to evaluate whether this had an effect superior to ACE inhibition. SHRSP drank 1% NaCl. Group 1 served as controls. Group 2 and 3 rats were started on losartan and enalapril after proteinuria exceeded 40 mg/day. Group 4 and 5 rats were started on losartan and enalapril after the first observation of cerebral edema with T2-weighted magnetic resonance imaging scans. In controls, median survival was 54 days (range, 35 to 80 days) after the start of salt loading. With early-onset losartan and enalapril, survival increased to 305 days (range, 184 to 422 days) and 320 days (range, 134 to 368 days) (both P < .01 v group 1). Cerebral edema formation was prevented in all but two rats, one from each treatment modality. Development of proteinuria was markedly reduced. With late-onset treatment with losartan and enalapril, survival was 290 days (range, 120 to 367 days) and 264 days (range, 154 to 319 days) (both P < .01). Both losartan and enalapril decreased cerebral edema to baseline levels. Ultimately cerebral edema reoccurred, despite continued treatment, in 75% of the rats. Systolic blood pressure did not decrease after losartan treatment, but, similarly to early-onset treatment, decreased transiently after enalapril treatment. Cerebral edema and proteinuria were prevented and reduced in SHRSP treated with either an AT1 receptor antagonist or an ACE inhibitor. Survival was markedly and similarly prolonged by both treatments, whether initiated directly before or after development of cerebral edema. In rats where treatment was initiated after manifestation of cerebral edema, both cerebral edema and proteinuria reappeared despite continued treatment. Apparently, when hypertension is sustained, reappearance of target organ damage may not be entirely dependent on angiotensin.     

氯沙坦、苯那普利及二者联合治疗高血压病的对比性研究

目的对比氯沙坦、苯那普利及二者联合治疗轻、中度原发性高血压(EH)的降压效果及耐受性.方法入选的轻、中度EH患者(坐位舒张压90～109 mmHg)经1周药物冲洗期及2周安慰剂期后,随机分为3组(1)L组,口服氯沙坦 50 mg/天;(2)B组,口服苯那普利 10 mg/天;(3)L+B组,口服氯沙坦 50 mg/天,苯那普利 10 mg/天.疗程8周.共入选病例67例,完成8周观察者63例,L组22例,B组20例,L+B组21例.于服安慰剂期末及治疗1、2、4、6、8周末测诊室血压、心率(HR)并记录不良反应.治疗前后测血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)浓度.结果治疗8周后三组血压均下降,其中L组下降10.8±6.2/17.5±5.5 mmHg,总有效率59.1%;B组下降11.2±5.4/16.4±4.6 mmHg,总有效率65.0%;L+B组下降26.4±5.7/32.1±11.0 mmHg,总有效率95.2%.L+B组降压幅度最大,与L组、B组比较有统计学意义(P＜0.001).L组与B组的降压幅度及有效率无显著差异(P＞0.05).三组血浆ALD浓度在治疗后均下降,其中L+B组ALD下降较L组与B组显著(P＜0.001).氯沙坦组不良反应少.结论氯沙坦有明显降压作用,与苯那普利合用有叠加效应.     

Efficacy and Safety of Irbesartan/HCTZ in Severe Hypertension According to Cardiometabolic Factors

J Clin Hypertens (Greenwich).2010;12:487–494. © 2010 Wiley Periodicals, Inc. This post hoc analysis of a 7-week, randomized, double-blind trial evaluated the efficacy and safety of initial irbesartan/hydrochlorothiazide treatment in 468 patients with severe, uncontrolled, hypertension (diastolic blood pressure [DBP] ≥100 mm Hg) at high cardiovascular risk. Systolic blood pressure (SBP)/DBP reductions ranged from 28.0 to 42.9/22.9 to 27.2 mm Hg in patients with obesity, diabetes, baseline SBP ≥180 mm Hg, and in the elderly. Blood pressure control to <140/90 mm Hg in the age and obesity subgroups ranged from 32.1% to 39.2% while control to <130/80 mm Hg in patients with diabetes was 11.5%. After 1 week of therapy, 72.5% of patients no longer had SBP ≥180 mm Hg; by 7 weeks, 51.3% had SBP 140 to 159 mm Hg and 26.5% had SBP <140 mm Hg. Treatment was well tolerated regardless of the subgroup. No excess of prespecified events was noted. Thus, initial treatment with irbesartan/hydrochlorothiazide was rapidly effective in high-risk, difficult-to-treat, severely hypertensive patients.     

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。     

Losartan versus atenolol on 24-hour ambulatory blood pressure. A LIFE substudy

Objective. The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study showed that losartan-based treatment reduced risk of the composite endpoint of cardiovascular death, stroke and myocardial infarction compared with atenolol-based treatment in patients with hypertension and left ventricular hypertrophy with similar office blood pressure (BP) reduction. Our aim was to investigate the effect of losartan- and atenolol-based treatment on 24-h ambulatory BP and heart rate (HR) in LIFE. Methods: In 110 patients, 24-h ambulatory BP and heart rate were recorded at baseline and 1 year after randomization. Results: Ambulatory BP was comparably reduced throughout the 24-h period after 1 year of losartan- vs atenolol-based antihypertensive treatment. Office and ambulatory BP were comparably reduced in the follow-up period. Early morning surge in BP was similar between groups. Non-dipping status was more frequent in the losartan group (p = 0.01). From baseline to Year 1 the 24-h HR profile for the losartan group was unchanged, but, as expected, there was a significant decrease in daytime HR in the atenolol group, which was not as large during early night-time. Conclusion: There were no differences in 24-h BP burden and HR that could explain the difference in outcome in favor of losartan vs atenolol in the LIFE study.     

Comparison of the Antihypertensive Efficacy of Irbesartan//HCTZ and Valsartan//HCTZ Combination Therapy: Impact of Age and Gender

This analysis aimed to explore whether low-dose irbesartan//hydrochlorothiazide (HCTZ) has superior blood pressure (BP)-lowering efficacy over low-dose valsartan//HCTZ in the elderly and across both genders. This is a post-hoc analysis of data from a multicenter, parallel group, open-label, blinded-endpoint study in patients with hypertension uncontrolled with HCTZ monotherapy. The reduction in systolic BP (SBP)//diastolic BP (DBP) and rate of BP control achieved following 8 weeks of treatment with irbesartan//HCTZ 150//12.5 mg or valsartan//HCTZ 80//12.5 mg were analyzed for older (≥65 years) vs. younger (<65 years) patients and for men vs. women. Blood pressure measurements were by home BP monitoring (HBPM). In the age and gender subgroups, both treatments significantly decreased home SBP and DBP (p < 0.0001). The reduction in home SBP and DBP was numerically greater with irbesartan//HCTZ compared to valsartan//HCTZ for all subgroups: the difference in DBP was significant for all except the elderly (p < 0.05), and the difference in SBP was significant in the elderly and in men (p < 0.03). In all subgroups, more patients achieved BP control (HBPM ≤135//85 mmHg) in the irbesartan//HCTZ arm (range 45%%–58%%) than in the valsartan//HCTZ arm (range, 23%%–39%%; p < 0.02). Both combination therapies were well tolerated and safety parameters were similar in both age and gender subgroups. More patients with mild or moderate hypertension, uncontrolled in HCTZ monotherapy alone, had their BP controlled with irbesartan//HCTZ 150//12.5 mg than with valsartan//HCTZ 80//12.5 mg, irrespective of age or gender.     

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。