Destro Maurizio, Cagnoni Francesca, D'Ospina Antonio, Ricci Alessandra Rossi, Demichele Elena, Peros Emmanouil, Zaninelli Augusto, Preti Paola
Internal Medicine, Ospedale Unificato Broni-Stradella, Stradella (PV), Italy.
Vasc Health Risk Manag. 2010 Apr 15;6:253-60. doi: 10.2147/vhrm.s6805.
The treatment of moderate or severe hypertension in most cases requires the contemporaneous use of multiple antihypertensive agents. The most available two-drug combinations have an agent that addresses renin secretion and another one that is statistically more effective in renin-independent hypertension. The practice of combining agents that counteract different mechanisms is the most likely explanation for the fact that most available two-drug combinations have an agent that addresses renin secretion (beta-blocker, angiotensin converting enzyme inhibitor, angiotensin II receptor blocker or direct renin inhibitor) and another one that is more effective in renin-independent hypertension (diuretic, dihydropyridine or non-dihydropyridine calcium channel blocker). Based on these considerations, addition of hydrochlorothiazide to the combination of an antagonist of the renin-angiotensin system with a calcium channel blocker would constitute a logical approach. Inclusion of a diuretic in the triple combination is based on the evidence that these agents are effective and cheap, enhance the effect of other antihypertensive agents, and add a specific effect to individuals with salt-sensitivity of blood pressure. The benefit of triple combination therapy with amlodipine, valsartan and hydrochlorothiazide over its dual component therapies has been demonstrated, and the use of a single pill will simplify therapy resulting in better blood pressure control.
在大多数情况下，治疗中度或重度高血压需要同时使用多种抗高血压药物。最常用的两种药物组合中，一种药物作用于肾素分泌，另一种在不依赖肾素的高血压中具有更高的统计学疗效。将作用于不同机制的药物联合使用，很可能是大多数常用的两种药物组合中，一种药物作用于肾素分泌（β受体阻滞剂、血管紧张素转换酶抑制剂、血管紧张素II受体阻滞剂或直接肾素抑制剂），另一种在不依赖肾素的高血压中更有效的原因。基于这些考虑，在肾素-血管紧张素系统拮抗剂与钙通道阻滞剂的组合中加入氢氯噻嗪将是一种合理的方法。三联组合中加入利尿剂是基于以下证据：这些药物有效且便宜，可增强其他抗高血压药物的效果，并对血压盐敏感个体产生特定作用。氨氯地平、缬沙坦和氢氯噻嗪三联联合治疗相对于其双组分治疗的益处已得到证实，使用单片制剂将简化治疗，从而更好地控制血压。
