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。

Discussion on Chinese, American and European guidelines for the medicines in the treatment of hypertension

The choice of medicines is a key point in the treatment of hypertension.There are hundreds of antihypertensive drugs in China,including Traditional Chinese Medicines(TCM),chemical medicines and all kinds of compound preparation.But the rates of treatment and control of hypertension in China are very low,the situation of hypertension management in China is critical.In this article we compared the differences in the drug treatment among Chinese,American and European guidelines for the management of hypertension,and discussed the principles of choosing antihypertensive drugs.Chinese,American and European guidelines all mention that the specific drug classes may differ in some effect or in special groups of patients,so certain compelling indication requires certain antihypertensive drug classes.Three guidelines also emphasize the benefits obtained from the combination therapy and recommend the long-acting drugs or preparations with 24 h efficacy.The main differences among the three guidelines is whether to recommend the firstline drugs.Thiazide-type diuretics are recommended by American guideline(JNC7) in drug treatment for most patients with uncomplicated hypertension.But the European and Chinese guidelines do not recommend the first-line drugs,and the major classes of antihypertensive agents are suitable for the initiation and maintenance of therapy.Traditional Chinese medicines are invaluable resource of China,all kinds of antihypertensive TCM are widely used in the clinical,but owing to the deficiency of the high-quality evidence for TCM,the part of TCM is not included in the 2004 Chinese guideline for the management of hypertension.The choice of antihypertensive drugs is determined by its efficacy and safety.When safety and efficacy are equal,the lowest cost drug should be preferred.For the majority of patients without a compelling indication for another class of drug,a low dose of thiazides diuretic should be considered as the first choice in China.2004 Chinese guideline for the management of hypertension is based on many scientific evidences,and its publication is very important for the prevention and cure of hypertension in China.Nowadays,we must strengthen the dissemination and implementation of guideline,promote the rational use of antihypertensive drugs and improve the control rate of hypertensive in China.