1+1>2:抗高血压药如何联用更合理?

2017-01-05 清风 华医网

抗高血压药物联合治疗的原则1.选择药代动力学和药效学上互补的药物①药代动力学主要考虑的是药物的体内过程,包括肝脏的代谢及肾脏的排泄;②药效学上互补主要是从药物的作用机理着手,作用机理不同的药物联合使用可以使降压效果增强。2.应避免联合使用降压原理相近的药物①临床上不主张把ACEI(血管紧张素转化酶抑制剂),ARB(血管紧张素II受体阻滞剂)及β受体阻滞剂两两联合应用;②ACEI与ARB作用机理是在

高血压药物联合治疗的原则

1.选择药代动力学和药效学上互补的药物

①药代动力学主要考虑的是药物的体内过程,包括肝脏的代谢及肾脏的排泄;

②药效学上互补主要是从药物的作用机理着手,作用机理不同的药物联合使用可以使降压效果增强。

2.应避免联合使用降压原理相近的药物

①临床上不主张把ACEI(血管紧张素转化酶抑制剂),ARB(血管紧张素II受体阻滞剂)及β受体阻滞剂两两联合应用;

②ACEI与ARB作用机理是在一系列的生理反应中阻断不同的环节,实际上是作用于一个生理系统;

③β受体阻滞剂的作用机理是通过肾素血管紧张素醛固酮系统,和ACEI、ARB类相近。

3.联合治疗应较单药治疗提高疗效,加强靶器官保护同时减少及抵消不良反应

4.长效和短效药物联合

①可提高患者对药物的依从性;

②此类联合可更好的控制平稳血压,利于对靶器官的保护。

5.简化治疗方法,尽可能降低费用

①根据患者的具体情况决定是否联合用药;

②患者需联合用药时,应该尽量选择较少的药物种类,并尽可能降低用药费用。

高血压药物联合使用的合理方案

1.利尿剂+ACEI/ARB 

利尿剂激活肾素-血管紧张素-醛固酮系统(RAAS),从而使作用于RAAS的ACEI作用更明显。

2.利尿剂+β受体阻滞剂

①利尿剂激活肾素,增快心率的作用可被β-阻滞剂抵消;

②β受体阻滞剂缩血管及促肾潴钠作用被噻嗪类利尿剂所抵消。

3.β受体阻滞剂+CCB(钙离子拮抗剂)

β受体阻滞剂有减慢心率的作用,而双氢吡啶类的钙离子拮抗剂可以反射性的加快心率。

4.CCB+ ACEI/ARB

CCB和ACEI,作用机理完全不同,可以联合使用。

5. β受体阻滞剂+α受体阻滞剂

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    2017-01-07 xmax889

    要根据药代与药效来决定怎么用

    0

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    2017-01-06 明月清辉

    谢谢了,很好

    0

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    2017-01-06 txqjm

    谢谢了,学习了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2039768, encodeId=e1cf2039e6828, content=<a href='/topic/show?id=bf0f5584ef6' target=_blank style='color:#2F92EE;'>#抗高血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55847, encryptionId=bf0f5584ef6, topicName=抗高血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87531, createdName=klivis, createdTime=Thu Nov 02 13:53:00 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2027102, encodeId=5a08202e102b5, content=<a href='/topic/show?id=5dd1558503e' target=_blank style='color:#2F92EE;'>#抗高血压药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55850, encryptionId=5dd1558503e, topicName=抗高血压药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Mon Jul 24 06:53:00 CST 2017, time=2017-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=168696, encodeId=fbf7168696c1, content=要根据药代与药效来决定怎么用, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160813/IMG57AE8D930B40D3563.jpg, createdBy=13a81695880, createdName=xmax889, createdTime=Sat Jan 07 23:51:00 CST 2017, time=2017-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=168284, encodeId=6b4e16828416, content=谢谢了,很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Fri Jan 06 09:02:07 CST 2017, time=2017-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=168244, encodeId=9ece1682441a, content=谢谢了,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30331616752, createdName=txqjm, createdTime=Fri Jan 06 06:51:00 CST 2017, time=2017-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=168243, encodeId=82271682437c, content=谢谢了,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30331616752, createdName=txqjm, createdTime=Fri Jan 06 06:50:45 CST 2017, time=2017-01-06, status=1, ipAttribution=)]
    2017-01-06 txqjm

    谢谢了,学习了

    0

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