治疗原发性高血压,单片复方制剂如何选?

2022-09-21 MedSci原创 MedSci原创 发表于上海

来看看指南怎么说?一文读懂~

点击下方链接,查看用药指南:

《血管紧张素转换酶抑制药/血管紧张素受体阻滞药联合钙通道阻滞剂单片复方制剂治疗原发性高血压中国专家共识(2022版)》

国家基层高血压防治管理指南2020 

单片复方制剂降压治疗中国专家共识

 

据数据显示,现阶段我国高血压患病人数已达到3.5亿。近年来,尽管高血压治疗手段有了显著改善,但我国高血压的防控形势依然严峻。

起始联合治疗原发性高血压 具有降压效果好、安全性高等优势,是降压治疗的基本原则之一。两种或以上降压药组成的单片复方制剂(SPC)治疗原发性高血压具有使用方便、患者依从性高、用药持续性好等特点。

SPC具有多种联合方式,其中血管紧张素转换酶抑制剂(ACEI/血管紧张素受体阻滞剂(ARB)联合钙通道阻滞剂 CCB)具有协同降压作用,可显著提升血压控制率。

近期,2022《血管紧张素转换酶抑制药/血管紧张素受体阻滞药联合钙通道阻滞剂单片复方制剂治疗原发性高血压中国专家共识》发布,从ACEI/ARB联合CCBA+C)降压机制出发,针对原发性高血压管理提出诸多意见,本文将重点梳理出来,以分享给各位同道,一起学习。

1A+C降压机制

ACEI/ARB主要通过作用于肾素-血管紧张素-醛固酮系统(RAAS)中血管紧张素转换酶(ACE)以及ACE2两条路径发挥作用。另 面,CCB通过阻滞L型钙通道,减少细胞外Ca2+ 向细胞内流动,降低胞浆内Ca2+ 浓度,舒张血管平滑肌,扩张动脉,降低血压。

图:ACEI/ARBCCB药理作用和机制

A+C降压机制起到了互补作用,ACEI/ARBCCB联合时具有加强降压效果、减少不良反应的协同作用。

2A+C SPC的临床应用

联合降压方案的复杂性和服药数量与患者对治疗 的依从性呈负相关。相比自由联合,SPC可简化降 压治疗方案,提高患者治疗依从性和血压达标率,起始用 SPC治疗较自由联合显著降低全因死亡率及因急性心肌梗死、心力衰竭或脑卒中住院风险。

ACEICCB ARBCCB SPC的区别与选择ACEICCBARBCCB SPC之间存在一定区别。目前, ACEICCB降低远期心血管事件的证据相对 ARBCCB 更加充分。在降压方面,相比ACEIARB的效果更加明显,不管是在持久度上,还是在依从性上都更好。

有研究显示,在一项超300 人的真实世界研究表明,应用 ACEI ARB治疗的原发性高血压患者,发生急性心肌梗死、心力衰竭、脑卒中或复合心血管事件的风险差异无统计学意义,但与ACEI相比,应用ARB者发生血管水肿、咳嗽、胰腺炎和胃肠道出血的风险显著降低。

ARB常以「沙坦」命名,包括缬沙坦、氯沙坦、厄贝沙坦、替米沙坦、坎地沙坦、奥美沙坦和阿利沙坦。其中,厄贝沙坦降压幅度较大,单药控制血压的达标率较高,吸收度高,药效持续时间长,在治疗高血压中占有重要地位。

目前,SPC 由于服用方便,易于长期坚持, 已成为高血压治疗的新模式,推荐首选。常用的单片复方制剂包括:培哚普利/氨氯地平、贝那普利/氨氯地平、缬沙坦/氨氯地平、替米沙坦/氨氯地平、奥美沙坦/氨氯地平等。

图:A+C SPC使用建议

总之,A+C方案具有降压疗效好、不良反应少、改善预后、保护靶器官等多种优势,SPC可提高用药依从性及血压达标率。

参考文献

1,孙英贤,赵连友,陈晓平,李玉明,蔡军,李悦,谢良地,冯颖青,王继光,崔兆强,尹新华,余静,田刚,李雪,姜一农,徐新娟,牛晓琳,商黔惠,郭子宏,赵海鹰,马建林,李勇.血管紧张素转换酶抑制药/血管紧张素受体阻滞药联合钙通道阻滞剂单片复方制剂治疗原发性高血压中国专家共识[J].中华高血压杂志,2022,30(07):610-619.DOI:10.16439/j.issn.1673-7245.2022.07.003.

2Panel of Chinese Expert Consensus on Antihypertensive Therapy with Single-pill Combination, Chinese Societyof Cardiology of the Chinese Medical Association and Committee of Cardio-Cerebral-Vascular Diseases of Chinese Gerontology Society. 单片复方制剂降压治疗中国专家共识[J]. 中华高血压杂志, 2012.

3国家心血管病中心国家基层高血压防治管理指南2020 [J]. 2022(3).

 

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    2022-12-28 delianjihui 来自新疆

    感谢分享

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2107928, encodeId=4586210e928d3, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:48:06 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107927, encodeId=c43d210e92799, content=非常实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:48:02 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107926, encodeId=6171210e926be, content=留存指导临床, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:47:48 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107925, encodeId=4199210e9250e, content=下载学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:47:33 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107924, encodeId=0519210e9243a, content=学习受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:47:24 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2089492, encodeId=96ba2089492b8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=abb76152142, createdName=baiwenxiu_6586, createdTime=Wed Sep 21 09:55:03 CST 2022, time=2022-09-21, status=1, ipAttribution=)]
    2022-12-28 delianjihui 来自新疆

    非常实用

    0

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    2022-12-28 delianjihui 来自新疆

    留存指导临床

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2107928, encodeId=4586210e928d3, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:48:06 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107927, encodeId=c43d210e92799, content=非常实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:48:02 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107926, encodeId=6171210e926be, content=留存指导临床, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:47:48 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107925, encodeId=4199210e9250e, content=下载学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:47:33 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107924, encodeId=0519210e9243a, content=学习受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:47:24 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2089492, encodeId=96ba2089492b8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=abb76152142, createdName=baiwenxiu_6586, createdTime=Wed Sep 21 09:55:03 CST 2022, time=2022-09-21, status=1, ipAttribution=)]
    2022-12-28 delianjihui 来自新疆

    下载学习

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2107928, encodeId=4586210e928d3, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:48:06 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107927, encodeId=c43d210e92799, content=非常实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:48:02 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107926, encodeId=6171210e926be, content=留存指导临床, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:47:48 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107925, encodeId=4199210e9250e, content=下载学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:47:33 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2107924, encodeId=0519210e9243a, content=学习受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Wed Dec 28 20:47:24 CST 2022, time=2022-12-28, status=1, ipAttribution=新疆), GetPortalCommentsPageByObjectIdResponse(id=2089492, encodeId=96ba2089492b8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=abb76152142, createdName=baiwenxiu_6586, createdTime=Wed Sep 21 09:55:03 CST 2022, time=2022-09-21, status=1, ipAttribution=)]
    2022-12-28 delianjihui 来自新疆

    学习受益

    0

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    2022-09-21 baiwenxiu_6586

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