Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic (IDIBAPS), University of Barcelona, Barcelona, Spain.
Research Institute, Fundación Oftalmológica de Santander and Medical School, Universidad de Santander, Bucaramanga, Colombia.
J Hypertens. 2018 Feb;36(2):208-220. doi: 10.1097/HJH.0000000000001593.
: Evidence from randomized trials has shown that effective treatment with blood pressure (BP)-lowering medications reduces the risk of cardiovascular morbidity and mortality in patients with hypertension. Therefore, hypertension control and prevention of subsequent morbidity and mortality should be achievable for all patients worldwide. However, many people in Latin America remain undiagnosed, untreated or have inadequately controlled BP, even where this is access to health systems. Barriers to hypertension control in low-income countries include difficulties in transportation to health services; inappropriate opening hours; difficulties in making clinic appointments; inaccessible healthcare facilities, lack of insurance and high treatment costs. After a review of the best recent available evidence on the efficacy and tolerability of antihypertensive drugs and strategies, the Latin American Society of Hypertension experts conclude that all major classes of BP-lowering drugs be available to hypertensive patients, because all have been shown to reduce major cardiovascular outcomes compared with placebo, and have shown to be associated with a comparable risk of major cardiovascular events and mortality when compared between classes. Within each class, no evidence whatsoever is available to show that one compound is more effective than another in outcome prevention. Therefore, the selection of individual drugs may be based mainly on the capacity of Latin American governments to obtain the lowest prices of the different molecules manufactured by companies with high production quality standards.
: 随机试验的证据表明，有效的降压药物治疗可降低高血压患者的心血管发病率和死亡率风险。因此，全世界所有患者都应能够控制血压并预防随后的发病和死亡。然而，拉丁美洲许多人仍然未被诊断、未接受治疗或血压控制不充分，即使他们能够获得卫生系统的服务。在低收入国家，控制高血压的障碍包括前往卫生服务机构的交通困难、不适当的开放时间、预约诊所困难、难以获得医疗保健设施、缺乏保险和治疗费用高昂。在对最近可获得的关于降压药物和策略的疗效和耐受性的最佳证据进行审查后，拉丁美洲高血压学会专家得出结论，所有主要类别的降压药物都应提供给高血压患者，因为所有药物都已被证明可降低与安慰剂相比的主要心血管结局，并且在类间比较时，与主要心血管事件和死亡率的风险相关。在每个类别中，都没有证据表明一种化合物在预防结果方面比另一种更有效。因此，个体药物的选择可能主要基于拉丁美洲各国政府获得具有高标准生产质量的公司制造的不同分子的最低价格的能力。
