全剂量ARBHCTZ联合降压治疗地位探讨讲义.ppt

* * * * Major clinical trials have demonstrated that patients typically needed treatment with multiple antihypertensive agents to get to, and stay at, BP goal. The number of antihypertensive agents required for BP control in many patients typically averages 2?4, with co-morbid conditions (such as kidney disease or diabetes mellitus) imposing greater drug requirement.1,2 For example, in the Hypertension Optimal Treatment (HOT) study, an average of 3.3 drugs were required to attain a diastolic BP goal of 80 mmHg, and in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA), most patients were taking at least two antihypertensive agents by the end of the trial.2,3 In the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial, patients were receiving initial treatment with single-pill combinations of antihypertensive agents. Excellent BP control rates were obtained with both the single-pill combinations used in the study.4 References 1. Sica DA. Rationale for fixed-dose combinations in the treatment of hypertension. The cycle repeats. Drugs 2002;62:443?62. 2. Bakris GL, et al. The importance of blood pressure control in the patient with diabetes. Am J Med 2004;116(5A):30S–8S. 3. Dahl?f B, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005;366:895?906. 4. Jamerson K, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008;359:2417?28. * 联合治疗 新指南指出基线血压显著升高或者CV高风险的患者应考虑起始两种联合治疗。两种RAS阻断剂的联合不被推荐及鼓励。其他药物联合在某种程度上都能更大程度的降压带来获益，然而应优先考虑在大型研究中成功应用（具有循证证据）的药物联合方案。高血压患者的治疗依从性低，两种药物的固定复方制剂通过减少每日服药数量改善依从性，因此优先推荐。 指南首次以表格形式汇总了不同药物联合的终点研究循证证据，其中ARB+D的循证证据为