Mazza Alberto, Sacco Antonella Paola, Townsend Danyelle M, Bregola Gianni, Contatto Edgardo, Cappello Isabella, Schiavon Laura, Ramazzina Emilio, Rubello Domenico
Hypertension Centre certified by the Italian Society of Hypertension, Hospital Santa Maria della Misericordia, Rovigo, Italy.
Unit of Internal Medicine, Department of Medicine, Hospital Santa Maria della Misericordia, Rovigo, Italy.
Biomed Pharmacother. 2017 Jun;90:665-669. doi: 10.1016/j.biopha.2017.04.008. Epub 2017 Apr 14.
The treatment of hypertensive patients (HTs) requires a long-term commitment of compliance for the patient and resources by the healthcare system. This poses an economic dilemma in countries where universal healthcare is standard. The aim of this study was to evaluate the costs/health benefit and effectiveness of treatment with angiotensin-II receptor blockers (ARBs) in uncomplicated essential hypertension.
The daily and annual economic commitment for treating patients with ARBs was estimated using pharmacy dispensing records and the BP-lowering effects of candesartan, irbesartan, losartan, olmesartan, telmisartan and valsartan was evaluated retrospectively. In 114 HTs (mean age 59.4±13.5year, 57.5% men), the BP-lowering effect of ARBs as in monotherapy and in fixed-dose combination (FDC) with hydrochlorothiazide at the doses commonly used in the market to reach BP control (i.e. BP <140/90mmHg) was analyzed. The BP lowering-effect was evaluated after an average of 6-month follow-up consulting medical professionals. Analysis of variance for repeated measures was provided.
Treatment with candesartan (14.1%) and olmesartan (32,4%) versus other ARBs resulted in a significant decrease in BP as for mono- than for FDC therapy. Our studies suggest that daily (data not shown) and annual costs of olmesartan were higher than candesartan as in mono- (4577.71±1120.55 vs. 894.25±127.75 €) than for FDC therapy (5715.90±459.90 vs. 1580.45±113.15 €).
Treatment: of BP with candesartan appears to be the most favorable option in terms of cost-effectiveness coupled with favorable health outcomes. These data have some limitations, but open the question if candesartan should be preferred to olmesartan in BP management. Further prospective studies comparing ARBs based on their effect on BP control in uncomplicated HTs are needed for validation.
高血压患者的治疗需要患者长期坚持依从治疗，同时医疗系统也需投入资源。在实行全民医保的国家，这带来了经济困境。本研究的目的是评估血管紧张素II受体阻滞剂（ARB）治疗单纯性原发性高血压的成本/健康效益及有效性。
利用药房配药记录估算使用ARB治疗患者的每日及年度经济投入，并回顾性评估坎地沙坦、厄贝沙坦、氯沙坦、奥美沙坦、替米沙坦和缬沙坦的降压效果。在114例高血压患者（平均年龄59.4±13.5岁，男性占57.5%）中，分析了ARB在单药治疗以及与氢氯噻嗪固定剂量联合（FDC）治疗时，按照市场常用剂量达到血压控制（即血压<140/90mmHg）的降压效果。在平均6个月的随访期后，咨询医学专业人员评估降压效果。提供重复测量方差分析。
与其他ARB相比，坎地沙坦（14.1%）和奥美沙坦（32.4%）治疗导致单药治疗比FDC治疗时血压显著降低。我们的研究表明，奥美沙坦的每日（数据未显示）及年度成本高于坎地沙坦，单药治疗时（4577.71±1120.55对894.25±127.75欧元），FDC治疗时（5715.90±459.90对l580.45±113.15欧元）。
就成本效益以及良好的健康结果而言，坎地沙坦治疗血压似乎是最有利的选择。这些数据有一些局限性，但引发了在血压管理中坎地沙坦是否应优于奥美沙坦的问题。需要进一步的前瞻性研究，根据ARB对单纯性高血压患者血压控制的影响进行比较以验证。
