Widimský J
Klinika kardiologie IKEM Praha.
Vnitr Lek. 2009 Feb;55(2):123-30.
Combination of drugs from different classes of antihypertensives provides an additional antihypertensive effect thus minimising the probability of adverse effects related to the dose of antihypertensive. Combination therapy is indicated for the following groups of hypertensive patients: (a) all hypertensive patients whose systolic blood pressure exceeds the target systolic blood pressure value by > 20 mm Hg, or whose diastolic blood pressure exceeds the target diastolic blood pressure value by > 10 mm Hg; (b) in patients with diabetes mellitus (because the target values are < 130/80 mm Hg); (c) patients with target organ damage; (d) patients with a kidney or cardiovascular disease (patients with IHD, patients after a cerebrovascular accident); (e) patients with overall cardiovascular risk according the SCORE > or = 5%. The advantage of fixed combinations resides in the fact that they increase compliance with treatment by reducing the number of pills taken by the patients. A fixed combination of the ACE inhibitor perindopril and the calcium channel blocker amlodipine proves optimal as has been shown by the results of the ASCOT-BPLA study. The launch of the above combination on this market should therefore be welcome. The fixed combination of perindopril and amlodipine will be indicated for hypertensive patients with uncontrolled hypertension or cardiovascular risk factors. This fixed combination will also be ideal for patients with a higher risk of diabetes mellitus, i.e. patients with a higher fasting glycaemia, in patients with impaired glucose tolerance and in patients with the metabolic syndrome. We strongly believe that it will improve the control of hypertension in our hypertensive patients, and improve the cardioprotective and nephroprotective effect of hypertension therapy.
联合使用不同类别的抗高血压药物可提供额外的降压效果,从而将与抗高血压药物剂量相关的不良反应概率降至最低。联合治疗适用于以下几组高血压患者:(a) 所有收缩压超过目标收缩压值>20 mmHg,或舒张压超过目标舒张压值>10 mmHg的高血压患者;(b) 糖尿病患者(因为目标值<130/80 mmHg);(c) 有靶器官损害的患者;(d) 患有肾脏或心血管疾病的患者(缺血性心脏病患者、脑血管意外后患者);(e) 根据SCORE心血管总体风险>或=5%的患者。固定复方制剂的优点在于,它们通过减少患者服用的药丸数量来提高治疗依从性。如ASCOT-BPLA研究结果所示,血管紧张素转换酶抑制剂培哚普利和钙通道阻滞剂氨氯地平的固定复方制剂被证明是最佳的。因此,上述复方制剂在该市场的推出应该受到欢迎。培哚普利和氨氯地平的固定复方制剂将适用于高血压未得到控制或有心血管危险因素的高血压患者。这种固定复方制剂对于糖尿病风险较高的患者,即空腹血糖较高的患者、糖耐量受损的患者和患有代谢综合征的患者也将是理想的。我们坚信,它将改善我们高血压患者的血压控制,并提高高血压治疗的心脏保护和肾脏保护作用。