Taddei Stefano
Department of Internal Medicine, University of Pisa, Pisa, Italy.
High Blood Press Cardiovasc Prev. 2012 Jun 1;19(2):55-7. doi: 10.1007/BF03262454.
Effective treatment of high blood pressure represents a key strategy for reducing the burden of hypertension-related cardiovascular diseases, mostly myocardial infarction and stroke. Despite these well established concepts, however, hypertension remains poorly controlled, worldwide. In addition, treated hypertensive patients often remain at higher risk compared with the normotensive population, even when a satisfactory blood pressure control is achieved, due to the high or very high added cardiovascular risk profile observed in these patients. An emerging strategy to improve blood pressure control and achieve this unmet target for cardiovascular disease prevention in hypertensive patients is represented by a more extensive use of rational and effective combination therapies with respect to monotherapy. Such an approach has been recently proposed even as first-line strategy in hypertensive patients at high added cardiovascular risk or in those in whom strict blood pressure control is required. Within the possible antihypertensive drug combinations currently available for the clinical management of hypertension, those based on the association of drugs inhibiting the renin-angiotensin system and thiazide diuretics or calcium channel blockers have demonstrated to be effective and safe in lowering both systolic and diastolic blood pressure levels with a good tolerability profile. In addition, these strategies have provided evidence for effective cardiovascular protection compared with conventional antihypertensive therapies. Among the antihypertensive drugs able to counteract the deleterious effects of abnormal activation of the renin-angiotensin system, angiotensin II receptor blockers have demonstrated to provide better tolerability profile and greater cardiovascular protection on hypertension-related organ damage compared with ACE inhibitors in randomized controlled clinical trials, in the presence of similar antihypertensive efficacy and safety. In particular, these drugs are characterized by lower rates of drug-related side effects, better compliance and adherence to prescribed antihypertensive regimens, and use in synergistic and rational combination therapies, all factors that may contribute to improve blood pressure control and reduce discontinuations from antihypertensive therapy in treated hypertensive patients.
有效治疗高血压是减轻高血压相关心血管疾病负担的关键策略，这些疾病主要是心肌梗死和中风。然而，尽管有这些已确立的概念，但在全球范围内，高血压的控制仍然很差。此外，即使血压得到满意控制，接受治疗的高血压患者与血压正常人群相比，往往仍处于较高风险中，因为在这些患者中观察到心血管风险显著增加或非常高。一种新出现的策略是，相对于单一疗法，更广泛地使用合理有效的联合疗法，以改善血压控制并实现高血压患者心血管疾病预防这一未满足的目标。最近，这种方法甚至被提议作为心血管风险显著增加的高血压患者或需要严格控制血压的患者的一线策略。在目前可用于高血压临床管理的可能的抗高血压药物组合中，基于抑制肾素 - 血管紧张素系统的药物与噻嗪类利尿剂或钙通道阻滞剂联合使用的组合，已证明在降低收缩压和舒张压水平方面是有效且安全的，耐受性良好。此外，与传统抗高血压疗法相比，这些策略已为有效的心血管保护提供了证据。在能够抵消肾素 - 血管紧张素系统异常激活的有害影响的抗高血压药物中，在随机对照临床试验中，与血管紧张素转换酶抑制剂相比，血管紧张素 II 受体阻滞剂在具有相似抗高血压疗效和安全性的情况下，已证明对高血压相关器官损伤具有更好的耐受性和更大的心血管保护作用。特别是，这些药物的特点是药物相关副作用发生率较低、对规定的抗高血压治疗方案的依从性和持续性更好，并且可用于协同和合理的联合疗法，所有这些因素都可能有助于改善血压控制并减少接受治疗的高血压患者停止抗高血压治疗的情况。
