替米沙坦与氯沙坦的比较：滴定至反应研究的荟萃分析。
Comparison of telmisartan versus losartan: meta-analysis of titration-to-response studies.
作者信息
Smith David H G, Cramer Maarten-Jan M, Neutel Joel M, Hettiarachchi Rohan, Koval Stephen
出版信息
Blood Press Monit. 2003 Jun;8(3):111-7. doi: 10.1097/00126097-200306000-00004.
OBJECTIVES
To compare the ability of telmisartan and losartan to reduce mean diastolic blood pressure (DBP) during the last 6 h of the 24-h dosing interval in a prospectively planned meta-analysis of ambulatory blood pressure monitoring (ABPM) data from two independent studies.
METHODS
Data were from two independent randomized, double-blind, double-dummy, titration-to-response studies conducted in patients with mild-to-moderate hypertension (seated cuff DBP 95-109 mmHg, 24-h mean ambulatory DBP >or=85 mmHg). After a 4-week placebo run-in period, patients received once-daily telmisartan 40 mg or losartan 50 mg, with up-titration after 4 weeks to telmisartan 80 mg or losartan 100 mg, respectively, if seated trough cuff DBP >or=90 mmHg. Blood pressures were recorded using ABPM immediately before randomization and after 8 weeks of active treatment. In addition, seated trough cuff blood pressures were measured at baseline and after 4 and 8 weeks of active treatment.
RESULTS
Titration to the higher dose was required in 60.1% of telmisartan patients and 69.5% of losartan patients (P=0.01). Reductions from baseline in the last 6 h mean ambulatory DBP with telmisartan and losartan were 6.6+/-0.4 and 5.1+/-0.4 mmHg, respectively (P<0.01, adjusted for baseline and study); the effects were homogeneous across the two studies. During the last 6 h of the 24-h dosing interval, telmisartan produced greater reductions in each of the observed hourly mean ambulatory DBP values. Telmisartan-induced reductions were also greater for the majority of the observed hourly mean ambulatory DBP values over the entire 24-h dosing interval. Reductions from baseline in the last 6 h adjusted mean ambulatory systolic blood pressure (SBP) for telmisartan and losartan were 9.9+/-0.6 and 7.8+/-0.6 mmHg, respectively (P=0.01). The 24-h profiles of ambulatory SBP hourly mean reductions were similar to those for DBP. Both telmisartan and losartan were found to be safe and well tolerated.
CONCLUSIONS
Telmisartan 40/80 mg is superior to losartan 50/100 mg in controlling DBP and SBP during the last 6 h of the 24-h dosing interval.
目的
在一项前瞻性计划的荟萃分析中，比较替米沙坦和氯沙坦在24小时给药间隔的最后6小时降低平均舒张压（DBP）的能力，该分析数据来自两项独立研究的动态血压监测（ABPM）。
方法
数据来自两项针对轻至中度高血压患者（坐位袖带舒张压95 - 109 mmHg，24小时动态平均舒张压≥85 mmHg）进行的独立随机、双盲、双模拟、滴定至有效反应的研究。经过4周的安慰剂导入期后，患者每日服用一次替米沙坦40 mg或氯沙坦50 mg，若坐位谷值袖带舒张压≥90 mmHg，则在4周后分别滴定至替米沙坦80 mg或氯沙坦100 mg。在随机分组前以及积极治疗8周后，使用ABPM记录血压。此外，在基线以及积极治疗4周和8周后测量坐位谷值袖带血压。
结果
60.1%的替米沙坦患者和69.5%的氯沙坦患者需要滴定至更高剂量（P = 0.01）。替米沙坦和氯沙坦在最后6小时动态平均DBP较基线的降低值分别为6.6±0.4和5.1±0.4 mmHg（P < 0.01，根据基线和研究进行调整）；两项研究的效应具有同质性。在24小时给药间隔的最后6小时内，替米沙坦在每个观察到的每小时平均动态DBP值上产生的降低幅度更大。在整个24小时给药间隔内，替米沙坦引起的降低在大多数观察到的每小时平均动态DBP值上也更大。替米沙坦和氯沙坦在最后6小时调整后的平均动态收缩压（SBP）较基线的降低值分别为9.9±0.6和7.8±0.6 mmHg（P = 0.01）。动态SBP每小时平均降低的24小时曲线与DBP相似。替米沙坦和氯沙坦均被发现安全且耐受性良好。
结论
在24小时给药间隔的最后6小时内，替米沙坦40/80 mg在控制DBP和SBP方面优于氯沙坦50/100 mg。
Zotero 插件