盘点常用降压药的优缺点 !

2016-12-27 佚名 医学之声

盘点临床常用几类降压药各自的优缺点及用法。高血压是一种以动脉血压持续升高为特征的进行性“心血管综合征”,常伴有其它危险因素、靶器官损害或临床疾患,需要进行综合干预。抗高血压治疗包括非药物和药物两种方法,大多数患者需长期、甚至终身坚持药物治疗,我们今天就一起盘点临床常用几类降压药各自的优缺点及用法。(1)CCB二氢吡啶类CCB无绝对禁忌证,降压作用强,对糖脂代谢无不良影响。我国抗高血压临床试验的证据

盘点临床常用几类降压药各自的优缺点及用法。

高血压是一种以动脉血压持续升高为特征的进行性“心血管综合征”,常伴有其它危险因素、靶器官损害或临床疾患,需要进行综合干预。抗高血压治疗包括非药物和药物两种方法,大多数患者需长期、甚至终身坚持药物治疗,我们今天就一起盘点临床常用几类降压药各自的优缺点及用法。

(1)CCB二氢吡啶类CCB无绝对禁忌证,降压作用强,对糖脂代谢无不良影响。我国抗高血压临床试验的证据较多,均证实其可显著减少脑卒中事件,故推荐基层使用二氢吡啶类CCB。适用于大多数类型的高血压,尤对老年高血压、单纯收缩期高血压、稳定性心绞痛、冠状动脉或颈动脉粥样硬化、周围血管病患者适用。可单药或与其他4类药联合应用。对伴有心力衰竭或心动过速者应慎用二氢吡啶类CCB,少数患者可有头痛、踝部水肿、牙龈增生等副作用。

(2)ACEI降压作用明确,保护靶器官证据较多,对糖脂代谢无不良影响;适用于1~2级高血压,尤对高血压合并慢性心力衰竭、心肌梗死后、心功能不全、心房颤动预防、糖尿病肾病、非糖尿病肾病、代谢综合征、蛋白尿/微量白蛋白尿患者有益。可与小剂量噻嗪类利尿剂或二氢吡啶类CCB合用。对双侧肾动脉狭窄、妊娠、高血钾者禁用;注意咳嗽等副作用,偶见血管神经性水肿等不良反应。

(3)ARB降压作用明确,保护靶器官作用确切,对糖脂代谢无不良影响;适用于1~2级高血压,尤对高血压合并左室肥厚、心力衰竭、心房颤动预防、糖尿病肾病、代谢综合征、微量白蛋白尿、蛋白尿患者有益,也适用于ACEI引起的咳嗽而不能耐受者。可与小剂量噻嗪类利尿剂或二氢吡啶类CCB合用。对双侧肾动脉狭窄、妊娠、高血钾者禁用;偶见血管神经性水肿等不良反应。

(4)噻嗪类利尿剂降压作用明确,小剂量噻嗪类利尿剂适用于1~2级高血压或脑卒中二级预防,也是难治性高血压的基础药物之一。利尿剂对老年高血压、心力衰竭患者尤其有益。可与ACEI或ARB、CCB合用。小剂量噻嗪类利尿剂基本不影响糖脂代谢。大剂量利尿剂对血钾、尿酸及糖代谢可能有一定影响,要注意定期检查血钾、血糖及尿酸。痛风为禁忌证。

(5)β受体阻滞剂降压作用明确,小剂量适用于高血压伴心肌梗死后、冠心病心绞痛、快速性心律失常、慢性心力衰竭或心率偏快(心率80次/min及以上)的1~2级高血压。对心血管高危患者的猝死有预防作用。可与二氢吡啶类CCB合用。对哮喘及Ⅱ~Ⅲ度房室传导阻滞患者禁用;慎用于慢性阻塞性肺气肿、糖耐量异常者或运动员。大剂量长期使用要注意对糖脂代谢的影响,高选择性b受体阻滞剂对糖脂代谢影响不大。注意支气管痉挛、心动过缓等副作用;不要突然停药,以免发生撤药综合征。

(6)固定低剂量复方制剂为常用的一类高血压治疗药物,其优点是使用方便,可改善治疗的依从性,应用时注意其相应组成成分的禁忌证和副作用。

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    2017-01-29 墨尔

    真的很好,对于临床用药指导效果很好。

    0

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    2017-01-29 墨尔

    厉害。

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=2068291, encodeId=a27520682910f, content=<a href='/topic/show?id=baa725e8823' target=_blank style='color:#2F92EE;'>#优缺点#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25788, encryptionId=baa725e8823, topicName=优缺点)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Jan 31 10:04:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173164, encodeId=45461e3164e6, content=真的很好,对于临床用药指导效果很好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ee471989203, createdName=墨尔, createdTime=Sun Jan 29 14:55:57 CST 2017, time=2017-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173163, encodeId=acf51e3163af, content=厉害。, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ee471989203, createdName=墨尔, createdTime=Sun Jan 29 14:55:25 CST 2017, time=2017-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291892, encodeId=07e9129189282, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Thu Dec 29 05:04:00 CST 2016, time=2016-12-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166390, encodeId=b04d166390da, content=实用有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85621649328, createdName=1ddc3547m22(暂无匿称), createdTime=Wed Dec 28 20:50:07 CST 2016, time=2016-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166154, encodeId=7ab81661546f, content=温习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62d381629, createdName=yafeiliutjh, createdTime=Tue Dec 27 21:03:58 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166092, encodeId=42f8166092de, content=不是很详细,但是大致的优缺点的确就是这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Tue Dec 27 14:27:28 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166085, encodeId=41a216608590, content=总结的好,优缺点一目了然,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Tue Dec 27 14:16:26 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166084, encodeId=a0b916608487, content=学习了,知道了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLPeNmuNF9ibgMfMOAs7Iic5MpiaU8RLmRH67xCKuk5wzfhb7G4ib7ia6z9lrnsTicj1nAUfEOMecZDtvvu/0, createdBy=d7f91939785, createdName=186****0580(小山羊), createdTime=Tue Dec 27 14:12:26 CST 2016, time=2016-12-27, status=1, ipAttribution=)]
    2016-12-28 1ddc3547m22(暂无匿称)

    实用有效

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2068291, encodeId=a27520682910f, content=<a href='/topic/show?id=baa725e8823' target=_blank style='color:#2F92EE;'>#优缺点#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25788, encryptionId=baa725e8823, topicName=优缺点)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Jan 31 10:04:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173164, encodeId=45461e3164e6, content=真的很好,对于临床用药指导效果很好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ee471989203, createdName=墨尔, createdTime=Sun Jan 29 14:55:57 CST 2017, time=2017-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173163, encodeId=acf51e3163af, content=厉害。, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ee471989203, createdName=墨尔, createdTime=Sun Jan 29 14:55:25 CST 2017, time=2017-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291892, encodeId=07e9129189282, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Thu Dec 29 05:04:00 CST 2016, time=2016-12-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166390, encodeId=b04d166390da, content=实用有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85621649328, createdName=1ddc3547m22(暂无匿称), createdTime=Wed Dec 28 20:50:07 CST 2016, time=2016-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166154, encodeId=7ab81661546f, content=温习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62d381629, createdName=yafeiliutjh, createdTime=Tue Dec 27 21:03:58 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166092, encodeId=42f8166092de, content=不是很详细,但是大致的优缺点的确就是这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Tue Dec 27 14:27:28 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166085, encodeId=41a216608590, content=总结的好,优缺点一目了然,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Tue Dec 27 14:16:26 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166084, encodeId=a0b916608487, content=学习了,知道了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLPeNmuNF9ibgMfMOAs7Iic5MpiaU8RLmRH67xCKuk5wzfhb7G4ib7ia6z9lrnsTicj1nAUfEOMecZDtvvu/0, createdBy=d7f91939785, createdName=186****0580(小山羊), createdTime=Tue Dec 27 14:12:26 CST 2016, time=2016-12-27, status=1, ipAttribution=)]
    2016-12-27 yafeiliutjh

    温习一下

    0

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    2016-12-27 smartxiuxiu

    不是很详细,但是大致的优缺点的确就是这样

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2068291, encodeId=a27520682910f, content=<a href='/topic/show?id=baa725e8823' target=_blank style='color:#2F92EE;'>#优缺点#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25788, encryptionId=baa725e8823, topicName=优缺点)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Jan 31 10:04:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173164, encodeId=45461e3164e6, content=真的很好,对于临床用药指导效果很好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ee471989203, createdName=墨尔, createdTime=Sun Jan 29 14:55:57 CST 2017, time=2017-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173163, encodeId=acf51e3163af, content=厉害。, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ee471989203, createdName=墨尔, createdTime=Sun Jan 29 14:55:25 CST 2017, time=2017-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291892, encodeId=07e9129189282, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Thu Dec 29 05:04:00 CST 2016, time=2016-12-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166390, encodeId=b04d166390da, content=实用有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85621649328, createdName=1ddc3547m22(暂无匿称), createdTime=Wed Dec 28 20:50:07 CST 2016, time=2016-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166154, encodeId=7ab81661546f, content=温习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62d381629, createdName=yafeiliutjh, createdTime=Tue Dec 27 21:03:58 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166092, encodeId=42f8166092de, content=不是很详细,但是大致的优缺点的确就是这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Tue Dec 27 14:27:28 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166085, encodeId=41a216608590, content=总结的好,优缺点一目了然,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Tue Dec 27 14:16:26 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=166084, encodeId=a0b916608487, content=学习了,知道了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLPeNmuNF9ibgMfMOAs7Iic5MpiaU8RLmRH67xCKuk5wzfhb7G4ib7ia6z9lrnsTicj1nAUfEOMecZDtvvu/0, createdBy=d7f91939785, createdName=186****0580(小山羊), createdTime=Tue Dec 27 14:12:26 CST 2016, time=2016-12-27, status=1, ipAttribution=)]
    2016-12-27 有备才能无患

    总结的好,优缺点一目了然,学习了

    0

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    2016-12-27 186****0580(小山羊)

    学习了,知道了。

    0

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