利尿剂治疗高血压中国专家共识解读.pptVIP

在一随机双盲的研究中比较了吲达帕胺+培哚普利和厄贝沙坦 (150 mg/天)的疗效. 该研究共入选47例平均动态血压≥140 mmHg的高血压患者，在4周的洗脱期后,患者被随机治疗3个月. 必要时(8周治疗后BP 140/90 mm Hg)调整药物剂量.血压正常的标准为:24小时ABPM均值140/90 同时SBP降低10 mm Hg.结果表明利尿剂联合降压达标率显著高于双倍剂量ARB（33.3% vs 65.2%） Introduction:?A study was undertaken in patients with essential hypertension to compare, by ambulatory blood pressure monitoring, the response to a fixed low dose of perindopril/indapamide with that to irbesartan.Patients and design:?After a 4-week placebo run-in period, 47 patients with a mean ambulatory blood pressure measurement (ABPM) ≥140mm Hg systolic and/or ≥90mm Hg diastolic were randomised, double-blind, to perindopril/indapamide (2/0.625mg; 24 patients) or irbesartan (150mg; 23 patients). Blood pressure normalisation rates were compared using Fishers exact test and blood pressure decreases using the paired t-test.Methods:?The total duration of the study was 12 weeks. If the clinic blood pressure 8 weeks later was ≥140/90mm Hg, the dose was doubled. The primary efficacy variable was a final 24-hour ABPM ≤140/90mm Hg, with a fall in systolic blood pressure ≥10mm Hg.Results:?More patients (15/23) achieved normalisation taking perindopril/indapamide than taking irbesartan (7/21) [p 0.02]. The mean 24-hour systolic and diastolic blood pressure fell by 17 ± 2.3/8 ± 1.3mm Hg (p 0.001), respectively, in patients taking perindopril/indapamide and by 14 ± 2.9/7 ± 1.6 (p 0.001), respectively, in patients taking irbesartan. The falls were not significantly different. Systolic and diastolic blood pressure divided into day, night and early morning time periods fell significantly in both groups, but the falls did not differ between treatments. Both treatments were well tolerated and there were no significant adverse biochemical effects.Conclusion:?A fixed low-dose combination of perindopril/indapamide had greater efficacy than irbesartan with a similarly well tolerated adverse effect profile. This makes it a suitable first-line treatment in patients with