Oster J R, Epstein M
Nephrology Section, VA Medical Center, Miami, FL 33125.
J Clin Hypertens. 1987 Sep;3(3):278-93.
Aside from the retrospective analysis of Clark and Troop (1), no large-scale controlled study has been designed specifically to assess the advantages and disadvantages of fixed-dose antihypertensive combinations. The use of fixed-dose antihypertensive combinations is no longer the anathema of the academician. The principal advantages of fixed-ratio combinations are simplicity of use, potentiation of blood-pressure-lowering efficacy, and potential counterbalancing of certain side effects. An additional advantage might be improvement in broad-based cost effectiveness, that is, a potential reduction in the need for frequent laboratory surveillance and in the frequency of office visits. The principal disadvantage is the relative inflexibility of dosage adjustment. Antihypertensive therapy should be initiated with a single drug preparation, with subsequent substitution of a combination product when appropriate. Tables 4 and 5 summarize, respectively, some of the important factors to consider and the theoretical requirements when contemplating the use of fixed-dose antihypertensive combinations. Diuretic/beta-blocker combinations are particularly attractive because of the enormous long-term experience with each component, their proven efficacy and additional salutary effects, their generally acceptable and sometimes offsetting side effects, and their potential for once-a-day dosing. It seems likely that CEI/diuretic and perhaps calcium-channel blocker/diuretic combinations also have great merit.
除了克拉克和特鲁普的回顾性分析（1）外，尚未专门设计大规模对照研究来评估固定剂量抗高血压联合用药的优缺点。固定剂量抗高血压联合用药已不再是学者们所忌讳的。固定比例联合用药的主要优点是使用简便、增强降压效果以及可能抵消某些副作用。另一个优点可能是提高总体成本效益，即有可能减少频繁进行实验室监测的需求以及门诊就诊的频率。主要缺点是剂量调整相对缺乏灵活性。抗高血压治疗应从单一药物制剂开始，随后在适当的时候改用联合产品。表4和表5分别总结了在考虑使用固定剂量抗高血压联合用药时需要考虑的一些重要因素和理论要求。利尿剂/β受体阻滞剂联合用药特别有吸引力，因为对每种成分都有丰富的长期经验，其已证实的疗效和额外的有益作用，其普遍可接受且有时相互抵消的副作用，以及每日一次给药的可能性。血管紧张素转换酶抑制剂/利尿剂以及或许钙通道阻滞剂/利尿剂联合用药似乎也有很大的优点。
