Peng Jie, Zhao Yingxin, Zhang Hua, Liu Zhendong, Wang Zhihao, Tang Mengxiong, Zhong Ming, Lu Fanghong, Zhang Wei
Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, China.
Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Ji'nan, China.
Hypertens Res. 2015 Feb;38(2):123-31. doi: 10.1038/hr.2014.148. Epub 2014 Oct 2.
High-normal blood pressure is considered a precursor of stage 1 hypertension that is associated with metabolic disorders. This study aims to investigate whether the pharmacologic treatment of high-normal blood pressure affects metabolism, especially in abdominally obese individuals, and the pharmacoeconomics of two antihypertensive agents, telmisartan and indapamide. Subjects with high-normal blood pressure were randomly assigned to receive telmisartan, indapamide or placebo for 3 years. All the subjects were instructed to modify their lifestyle to reduce blood pressure throughout the study. A total of 221 subjects were randomly assigned to telmisartan, 213 to indapamide and 230 to placebo. After the 3-year intervention, blood pressure was lower in the telmisartan and indapamide groups (P<0.05), FPG in the telmisartan group was lower during the first 2 years (P<0.05) and no characteristic differences were found in those with abdominal obesity among the three groups (P>0.05). The percentage of subjects with metabolic syndrome was significantly decreased in the telmisartan and indapamide groups (P<0.05), but was only significantly decreased in the telmisartan group for subjects with abdominal obesity (P<0.05). The acquisition cost for telmisartan was ~1.86 times higher than for indapamide for a similar antihypertensive effect. The intervention for high-normal blood pressure with telmisartan and indapamide appeared to be feasible and reduced the risk of metabolic syndrome. Telmisartan was more effective, whereas indapamide had better pharmacoeconomic benefits.
血压略高于正常被认为是1期高血压的先兆，与代谢紊乱相关。本研究旨在调查血压略高于正常的药物治疗是否会影响代谢，尤其是腹型肥胖个体的代谢，以及两种抗高血压药物替米沙坦和吲达帕胺的药物经济学。血压略高于正常的受试者被随机分配接受替米沙坦、吲达帕胺或安慰剂治疗3年。在整个研究过程中，所有受试者均被指导改变生活方式以降低血压。共有221名受试者被随机分配至替米沙坦组，213名至吲达帕胺组，230名至安慰剂组。3年干预后，替米沙坦组和吲达帕胺组的血压较低（P<0.05），替米沙坦组在最初2年的空腹血糖较低（P<0.05），三组腹型肥胖者之间未发现特征性差异（P>0.05）。替米沙坦组和吲达帕胺组代谢综合征受试者的百分比显著降低（P<0.05），但腹型肥胖受试者仅在替米沙坦组显著降低（P<0.05）。对于相似的降压效果，替米沙坦的购置成本比吲达帕胺高约1.86倍。用替米沙坦和吲达帕胺干预血压略高于正常似乎是可行的，并降低了代谢综合征的风险。替米沙坦更有效，而吲达帕胺具有更好的药物经济学效益。
