Mengden Thomas, Uen Sakir, Bramlage Peter
Centre of Vascular Medicine, Herz- und Gefäss-Campus, Bad Nauheim, Germany.
Vasc Health Risk Manag. 2009;5:1043-58. doi: 10.2147/vhrm.s5549. Epub 2009 Dec 29.
Hypertension treatment and control is largely unsatisfactory when guideline-defined blood pressure goal achievement and maintenance are considered. Patient- and physician-related factors leading to non-adherence interfere in this respect with the efficacy, tolerability, and convenient use of pharmacological treatment options. Blockers of the renin-angiotensin system (RAS) are an important component of antihypertensive combination therapy. Thiazide-type diuretics are usually added to increase the blood pressure lowering efficacy. Fixed drug-drug combinations of both principles like candesartan/hydrochlorothiazide (HCTZ) are highly effective in lowering blood pressure while providing improved compliance, a good tolerability, and largely neutral metabolic profile. Comparative studies with losartan/HCTZ have consistently shown a higher clinical efficacy with the candesartan/HCTZ combination. Data on the reduction of cardiovascular endpoints with fixed dose combinations of antihypertensive drugs are however scarce, as are the data for candesartan/HCTZ. But many trials have tested candesartan versus a non-RAS blocking comparator based on a standard therapy including thiazide diuretics. The indications tested were heart failure and stroke and particular emphasis was put on elderly patients or those with diabetes. In patients with heart failure, for example, the fixed dose combination might be applied in patients in whom individual titration resulted in a dose of 32 mg candesartan and 25 mg HCTZ which can then be combined into one tablet to increase compliance with treatment. Also in patients with stroke the fixed dose combination might be used in patients in whom maintenance therapy with both components is considered. Taken together candesartan/HCTZ assist both physicians and patients in achieving long-term blood pressure goal achievement and maintenance.
从指南定义的血压目标达成和维持情况来看，高血压治疗和控制在很大程度上并不理想。导致不依从的患者和医生相关因素在这方面干扰了药物治疗方案的疗效、耐受性和使用便利性。肾素 - 血管紧张素系统（RAS）阻滞剂是抗高血压联合治疗的重要组成部分。通常会加用噻嗪类利尿剂以提高降压效果。坎地沙坦/氢氯噻嗪（HCTZ）等两种药物的固定复方制剂在降低血压方面非常有效，同时具有更好的依从性、良好的耐受性和基本中性的代谢特征。与氯沙坦/HCTZ的比较研究一直表明，坎地沙坦/HCTZ组合具有更高的临床疗效。然而，关于抗高血压药物固定剂量组合降低心血管终点事件的数据很稀少，坎地沙坦/HCTZ的数据也是如此。但许多试验已将坎地沙坦与基于包括噻嗪类利尿剂的标准疗法的非RAS阻断对照药物进行了比较。所测试的适应症包括心力衰竭和中风，特别关注老年患者或糖尿病患者。例如，在心力衰竭患者中，固定剂量组合可应用于那些通过个体化滴定得出坎地沙坦剂量为32毫克和氢氯噻嗪剂量为25毫克的患者，然后可将这两种成分合并制成一片药以提高治疗依从性。同样，在中风患者中，固定剂量组合可用于那些考虑使用两种成分进行维持治疗的患者。总体而言，坎地沙坦/HCTZ有助于医生和患者实现长期血压目标的达成和维持。
