Department of Primary Health Care, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK.
Heart. 2011 Nov;97(21):1771-5. doi: 10.1136/hrt.2010.221473. Epub 2011 May 17.
There are no evidence syntheses available to guide clinicians on when to titrate antihypertensive medication after initiation.
To model the blood pressure (BP) response after initiating antihypertensive medication. Data sources electronic databases including Medline, Embase, Cochrane Register and reference lists up to December 2009.
Trials that initiated antihypertensive medication as single therapy in hypertensive patients who were either drug naive or had a placebo washout from previous drugs.
Office BP measurements at a minimum of two weekly intervals for a minimum of 4 weeks. An asymptotic approach model of BP response was assumed and non-linear mixed effects modelling used to calculate model parameters.
Eighteen trials that recruited 4168 patients met inclusion criteria. The time to reach 50% of the maximum estimated BP lowering effect was 1 week (systolic 0.91 weeks, 95% CI 0.74 to 1.10; diastolic 0.95, 0.75 to 1.15). Models incorporating drug class as a source of variability did not improve fit of the data. Incorporating the presence of a titration schedule improved model fit for both systolic and diastolic pressure. Titration increased both the predicted maximum effect and the time taken to reach 50% of the maximum (systolic 1.2 vs. 0.7 weeks; diastolic 1.4 vs. 0.7 weeks).
Estimates of the maximum efficacy of antihypertensive agents can be made early after starting therapy. This knowledge will guide clinicians in deciding when a newly started antihypertensive agent is likely to be effective or not at controlling BP.
目前尚无证据综合可以指导临床医生在开始使用抗高血压药物后何时进行滴定。
建立降压药物起始治疗后血压（BP）反应模型。
电子数据库包括 Medline、Embase、Cochrane 注册库和参考文献，检索截至 2009 年 12 月。
入选的试验为起始单药治疗的高血压患者，患者为初治或停用前药的安慰剂洗脱期。
至少每周两次测量诊室 BP，至少 4 周。假设 BP 反应呈渐近模型，采用非线性混合效应模型计算模型参数。
共纳入 18 项试验，4168 例患者符合纳入标准。达到最大估计 BP 降低效果 50%的时间为 1 周（收缩压 0.91 周，95%CI 0.74 至 1.10；舒张压 0.95，0.75 至 1.15）。纳入药物类别作为变异源的模型并不能改善数据拟合。纳入滴定方案可改善收缩压和舒张压的模型拟合。滴定增加了最大预测效应和达到最大效应 50%的时间（收缩压 1.2 比 0.7 周；舒张压 1.4 比 0.7 周）。
可在开始治疗后早期估计抗高血压药物的最大疗效。该知识将指导临床医生决定新开始的抗高血压药物何时可能有效或无效控制 BP。
