Nishimura Takuya, Hashimoto Junichiro, Ohkubo Takayoshi, Kikuya Masahiro, Metoki Hirohito, Asayama Kei, Totsune Kazuhito, Imai Yutaka
Department of Clinical Pharmacology and Therapeutics, Tohoku University School of Pharmaceutical Science and Medicine, Sendai, Japan.
Clin Exp Hypertens. 2005 Aug;27(6):477-89. doi: 10.1081/CEH-200067668.
Our objective was to compare the efficacy and duration of action of 4 angiotensin II receptor blockers (ARBs)--losartan (25-100 mg), candesartan (2-12 mg), valsartan (40-80 mg), and telmisartan (10-40 mg)-in patients with essential hypertension using self-measurement of blood pressure at home (home BP) and to examine the differential effect of the four ARBs on home pulse pressure (home PP). After a 2-week run-in period, each of the 4 ARBs was assigned to subjects who were diagnosed as having hypertension on the basis of home BP and who were over 30 years old. The subjects were asked to take the ARB once daily in the morning and to measure home BP once in the evening and in the morning. We compared the efficacy of each ARB on home BP and home PP and assessed the duration of the BP-lowering effect using the morning effect versus evening effect ratio (M/E ratio). The antihypertensive effects of telmisartan on home systolic BP (SBP) both in the evening and in the morning and on home diastolic BP (DBP) in the morning were significantly greater than those of losartan. The effect of each ARB on home BP in the morning and in the evening was expressed as a ratio (M/E ratio). The M/E ratios of SBP/DBP in patients treated with losartan, candesartan, valsartan, and telmisartan were 0.49/0.16, 0.69/1.01, 0.82/0.88, and 0.88/0.88, respectively. The home PP-lowering effect was greater for valsartan and telmisartan than for losartan and candesartan in the morning. Among the 4 ARBs, the duration of the BP-lowering effect of losartan did not persist throughout 24 hr. The effects of the other 3 ARBs, in particular telmisartan, persisted over 24 hr when they were administered once daily in the morning. In addition, the duration of the PP-lowering effect was similar to that of the BP-lowering effect. Such long-acting property of several ARBs is essential for the modern antihypertensive treatment, and home BP measurements are useful for determining the duration of action of antihypertensive drugs. Losartan, 25 mg a day, which is usually used as an initial dose in Japan, is apparently insufficient to obtain adequate antihypertensive effect and sufficient duration of action.
我们的目标是，通过家庭自测血压（家庭血压），比较4种血管紧张素II受体阻滞剂（ARB）——氯沙坦（25 - 100毫克）、坎地沙坦（2 - 12毫克）、缬沙坦（40 - 80毫克）和替米沙坦（10 - 40毫克）——对原发性高血压患者的疗效和作用持续时间，并研究这4种ARB对家庭脉压（家庭PP）的不同影响。在为期2周的导入期后，将4种ARB分别分配给根据家庭血压被诊断为患有高血压且年龄超过30岁的受试者。受试者被要求每天早晨服用一次ARB，并在晚上和早晨各测量一次家庭血压。我们比较了每种ARB对家庭血压和家庭PP的疗效，并使用早晨效应与晚上效应比（M/E比）评估降压作用的持续时间。替米沙坦对晚上和早晨的家庭收缩压（SBP）以及早晨的家庭舒张压（DBP）的降压作用均显著大于氯沙坦。每种ARB对早晨和晚上家庭血压的作用以比值（M/E比）表示。接受氯沙坦、坎地沙坦、缬沙坦和替米沙坦治疗的患者，其SBP/DBP的M/E比分别为0.49/0.16、0.69/1.01、0.82/0.88和0.88/0.88。早晨，缬沙坦和替米沙坦对家庭PP的降低作用大于氯沙坦和坎地沙坦。在这4种ARB中，氯沙坦的降压作用持续时间在24小时内并不持久。当其他3种ARB每天早晨服用一次时，其作用持续超过24小时，尤其是替米沙坦。此外，PP降低作用的持续时间与降压作用的持续时间相似。几种ARB的这种长效特性对现代降压治疗至关重要，家庭血压测量有助于确定降压药物的作用持续时间。在日本通常用作初始剂量的每天25毫克氯沙坦，显然不足以获得足够的降压效果和充分的作用持续时间。
