Meredith Peter A
Department of Medicine and Therapeutics, Division of Cardiovascular and Medical Science, Gardiner Institute, Glasgow Western Infirmary, Glasgow, UK.
Am J Cardiovasc Drugs. 2005;5(3):171-83. doi: 10.2165/00129784-200505030-00004.
Angiotensin II receptor antagonists (angiotensin receptor blockers; ARBs) and thiazide diuretics have an accepted place in the management of hypertension. Most patients require combination therapy with two or more drugs to adequately control blood pressure to targets recommended by European and international guidelines. ARBs and the thiazide diuretic hydrochlorothiazide have complementary modes of action. Fixed-dose combinations of an ARB and low-dose hydrochlorothiazide provide a convenient and effective treatment option for patients who do not achieve blood pressure targets on monotherapy, without compromising the placebo-like tolerability of ARBs. In Europe, fixed-dose combinations with hydrochlorothiazide currently are available for the ARBs candesartan, eprosartan, irbesartan, losartan, telmisartan, and valsartan. Recently, a number of studies have focused on the use of ARBs in monotherapy and in combination therapy, in conditions including congestive heart failure, post-myocardial infarction management, hypertension with cardiovascular risk factors, and diabetic and non-diabetic nephropathy. Evidence from these studies suggests a beneficial role beyond the antihypertensive effect of these therapies in providing protection against cardiovascular, renovascular, and cerebrovascular events.
血管紧张素II受体拮抗剂（血管紧张素受体阻滞剂；ARBs）和噻嗪类利尿剂在高血压治疗中具有公认的地位。大多数患者需要两种或更多药物联合治疗，以将血压充分控制到欧洲和国际指南推荐的目标水平。ARBs和噻嗪类利尿剂氢氯噻嗪具有互补的作用方式。对于单药治疗未达血压目标的患者，ARB与低剂量氢氯噻嗪的固定剂量组合提供了一种方便有效的治疗选择，且不影响ARB类似安慰剂的耐受性。在欧洲，目前与氢氯噻嗪的固定剂量组合可用于坎地沙坦、依普罗沙坦、厄贝沙坦、氯沙坦、替米沙坦和缬沙坦等ARBs。最近，一些研究聚焦于ARBs在单药治疗和联合治疗中的应用，涉及充血性心力衰竭、心肌梗死后管理、伴有心血管危险因素的高血压以及糖尿病和非糖尿病肾病等情况。这些研究的证据表明，这些疗法除了具有降压作用外，在预防心血管、肾血管和脑血管事件方面还有有益作用。
