College of Pharmacy, University of Utah, Salt Lake City, Utah 84112, USA.
Drugs Aging. 2010 Nov 1;27(11):871-83. doi: 10.2165/11538650-000000000-00000.
The demographic shift towards an older population increases the public health burden. Two conditions, commonly occurring together, that contribute to this burden are hypertension and diabetes mellitus. Effective blood pressure (BP) control is particularly important in this patient population, with a recommended BP goal of <130/80 mmHg. Most of these patients will require treatment with a combination of antihypertensive agents to reach this goal. Polypharmacy can be defined as the use of two or more medications, and it is commonly seen in this patient population. The risks of polypharmacy and the potential for inappropriate therapy must be considered and balanced against the possible benefits of multiple drug therapies. An optimal approach to reducing the risks and maximizing the benefits of polypharmacy should include regular reviews of patients' medication lists, which can be changed to include, where appropriate, combination therapy and the use of single-pill combinations. Combination therapy can achieve greater BP reductions than monotherapy and can also enhance the safety and tolerability of pharmacotherapy. The safety and efficacy of numerous antihypertensive combinations in elderly patients have been demonstrated in a number of clinical trials. Single-pill formulations can simplify the medication regimen, and specific combinations can offer further benefits, such as enhanced reduction of macrovascular and microvascular complications, independent of BP reductions. Rational combination therapy can maximize BP control along with glycaemic control and help maximize the benefits of polypharmacy on outcomes in elderly patients with hypertension and co-morbid diabetes.
人口老龄化的趋势增加了公共卫生负担。两种常见的共同发生的疾病，高血压和糖尿病，导致了这种负担。在这种患者人群中，有效控制血压（BP）尤为重要，建议的 BP 目标为 <130/80mmHg。为了达到这一目标，大多数患者需要联合使用多种降压药物进行治疗。联合使用两种或两种以上药物的情况被定义为“多药治疗”，在该患者人群中很常见。必须考虑多药治疗的风险和潜在的不适当治疗，并权衡多种药物治疗的可能益处。降低多药治疗风险和最大化获益的最佳方法包括定期审查患者的用药清单，必要时可以包括联合治疗和使用单片复方制剂。联合治疗可以比单药治疗更有效地降低血压，还可以提高药物治疗的安全性和耐受性。多项临床试验已经证明了许多在老年患者中使用的降压联合治疗的安全性和有效性。单片制剂可以简化治疗方案，特定的联合治疗可以提供进一步的益处，例如独立于血压降低，更有效地减少大血管和微血管并发症。合理的联合治疗可以最大限度地控制血压和血糖，帮助老年高血压合并糖尿病患者从多药治疗中获得最大的获益。
