Okura Takafumi, Higaki Jitsuo
Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine.
Nihon Rinsho. 2009 Apr;67(4):819-25.
Recent data and hypertension treatment guidelines supported the use of a combination strategy as initial antihypertensive therapy in high-risk patients with stage 2 hypertension. Numerous studies have demonstrated that additive effects on blood pressure lowering when using combination angiotensin receptor blockers (ARB) and diuretics. The potassium -sparing properties of ARB compensate for hypokalemia induced by thiazide diuretics. Ca channel blockers (CCB) have a potent vasodilatory effect, but it enhances sympathetic nervous activity which is suppressed by the combination with ARBs. Combining ARB and CCB is useful in not only additive blood pressure lowering but also decrease in lower extremity edema induced by CCB. In near future, we may be able to use many fixed-dose combination antihypertensive agents, ARB with diuretics or CCB.
近期数据和高血压治疗指南支持将联合治疗策略作为2级高血压高危患者的初始抗高血压治疗方法。大量研究表明，联合使用血管紧张素受体阻滞剂（ARB）和利尿剂时，对降低血压具有相加作用。ARB的保钾特性可补偿噻嗪类利尿剂所致的低钾血症。钙通道阻滞剂（CCB）具有强大的血管舒张作用，但它会增强交感神经活性，而与ARB联合使用可抑制这种活性。联合使用ARB和CCB不仅有助于相加降低血压，还可减少CCB所致的下肢水肿。在不久的将来，我们或许能够使用多种固定剂量的联合抗高血压药物，即ARB与利尿剂或CCB的联合制剂。
