Ruilope Luis M
Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain.
Vasc Health Risk Manag. 2008;4(6):1237-48. doi: 10.2147/vhrm.s3642.
Hypertension is a major risk factor for cardiovascular disease that contributes to the premature death of millions of people each year, and identification and treatment of hypertension continues to be a challenge. Guidelines recommend that many patients will require two or more antihypertensive agents from different classes. Combining an angiotensin II receptor blocker (ARB) with hydrochlorothiazide (HCTZ) has been shown in clinical studies to increase the antihypertensive efficacy of both agents compared with either agent alone. This review covers several clinical trials and aims to examine several aspects of the efficacy of the combination of olmesartan and HCTZ, including dose-responsiveness, long-term efficacy, goal rate achievement, and efficacy in patients with moderate to severe hypertension. The results presented here demonstrate that olmesartan is effective when added to HCTZ monotherapy or when HCTZ is added to olmesartan monotherapy, both over the short and long term. Moderate to severe hypertension responds well to olmesartan/HCTZ combination therapy, and the great majority of patients are able to achieve recommended blood pressure targets. Thus olmesartan/HCTZ is a well-tolerated option for patients who fail to respond to monotherapy and as initial therapy in those who require large reductions in diastolic blood pressure or systolic blood pressure to achieve goal blood pressure.
高血压是心血管疾病的主要危险因素，每年导致数百万人过早死亡，高血压的识别和治疗仍然是一项挑战。指南建议，许多患者需要两种或更多种不同类型的抗高血压药物。临床研究表明，与单独使用任何一种药物相比，将血管紧张素II受体阻滞剂（ARB）与氢氯噻嗪（HCTZ）联合使用可提高两种药物的降压效果。本综述涵盖了多项临床试验，旨在研究奥美沙坦与HCTZ联合使用疗效的几个方面，包括剂量反应性、长期疗效、目标达标率以及在中重度高血压患者中的疗效。此处给出的结果表明，无论是短期还是长期，在HCTZ单药治疗中加用奥美沙坦或在奥美沙坦单药治疗中加用HCTZ均有效。中重度高血压对奥美沙坦/HCTZ联合治疗反应良好，绝大多数患者能够达到推荐的血压目标。因此，对于单药治疗无反应的患者以及那些需要大幅降低舒张压或收缩压以达到目标血压的患者，奥美沙坦/HCTZ是一种耐受性良好的初始治疗选择。
