Basile J N, Chrysant S
Ralph H Johnson VA Medical Center, Medical University of South Carolina, Charleston, SC 29401, USA.
J Hum Hypertens. 2006 Mar;20(3):169-75. doi: 10.1038/sj.jhh.1001972.
Desirable features of antihypertensive agents include efficacy, tolerability, prolonged duration of action and rapid achievement of target blood pressure (BP). Recent studies have examined the relationship between the onset of antihypertensive effect and cardiovascular events. Data from the Valsartan Antihypertensive Long-term Use Evaluation (VALUE), the Study on Cognition and Prognosis in the Elderly (SCOPE), and the Systolic Hypertension in Europe (Syst-Eur) trials support the hypothesis that the time it takes to reach target BP influences cardiovascular outcomes. VALUE, which compared BP-lowering and clinical event rates between patients treated with the angiotensin II receptor blocker (ARB) valsartan or the calcium channel blocker (CCB) amlodipine as well as between those who achieved immediate or delayed BP control, provides the strongest evidence of this to date. Additional data from SCOPE and Syst-Eur suggest that delays of 3 months to 2 years in starting antihypertensive therapy can increase the risk of certain cardiovascular end points, especially stroke. These data suggest that it may be beneficial to examine the efficacy of antihypertensive agents, not only long term, but also at earlier times to assess the onset and impact of early antihypertensive effect. The ARB olmesartan medoxomil (olmesartan) and the CCB amlodipine were compared in a randomized, double-blind, placebo-controlled clinical trial, which demonstrated that the onset of antihypertensive effect of olmesartan is comparable with that of amlodipine. Another study demonstrated that more patients treated with olmesartan achieved target BPs within 2 weeks of treatment compared with the ARBs losartan, valsartan and irbesartan.
抗高血压药物的理想特性包括疗效、耐受性、作用持续时间长以及能快速达到目标血压（BP）。最近的研究探讨了抗高血压作用的起效时间与心血管事件之间的关系。缬沙坦抗高血压长期使用评估（VALUE）、老年人认知与预后研究（SCOPE）以及欧洲收缩期高血压（Syst-Eur）试验的数据支持了这样一种假设，即达到目标血压所需的时间会影响心血管结局。VALUE试验比较了使用血管紧张素II受体阻滞剂（ARB）缬沙坦或钙通道阻滞剂（CCB）氨氯地平治疗的患者之间的降压效果和临床事件发生率，以及那些立即或延迟实现血压控制的患者之间的情况，这是迄今为止关于这一点的最有力证据。SCOPE和Syst-Eur的其他数据表明，开始抗高血压治疗延迟3个月至2年可能会增加某些心血管终点事件的风险，尤其是中风。这些数据表明，不仅长期，而且在更早的时候检查抗高血压药物的疗效，以评估早期抗高血压作用的起效和影响可能是有益的。在一项随机、双盲、安慰剂对照的临床试验中，对ARB奥美沙坦酯（奥美沙坦）和CCB氨氯地平进行了比较，结果表明奥美沙坦的抗高血压作用起效时间与氨氯地平相当。另一项研究表明，与ARB类药物氯沙坦、缬沙坦和厄贝沙坦相比，更多接受奥美沙坦治疗的患者在治疗2周内达到了目标血压。
