Lopatowska Paulina, Mlodawska Elzbieta, Tomaszuk-Kazberuk Anna, Banach Maciej, Malyszko Jolanta
a Department of Cardiology , Medical University in Bialystok , Bialystok , Poland.
b Department of Hypertension , WAM University Hospital in Lodz, Medical University of Lodz (MUL) , Lodz , Poland.
Expert Rev Clin Pharmacol. 2018 Feb;11(2):165-170. doi: 10.1080/17512433.2018.1412826. Epub 2017 Dec 6.
Hypertension is one of the primary modifiable risk factor for cardiac and renal diseases with the prevalence around 30-45% of the general population, with a steep increase with ageing. The administration of blood pressure-lowering drugs is to reduce the risk of major clinical cardiovascular outcomes. Hypertension guidelines recommend combination therapy in patients with high cardiovascular risk and with subclinical organ damage as well as when monotherapy fails. Areas covered: As the etiology of essential hypertension is multifactorial, combination therapy using different classes of antihypertensive agents have greater effect than each on its own (synergistic effect), may have better tolerability (two components minimizing each other's side effects) and lead to improved patient compliance. Several studies assess the hypotensive efficacy on drug combination; there are also studies on triple drug combination. Expert commentary: At present, dual and triple combination therapy is available to hypertensive patients with good clinical outcomes, compliance and low profile of side effects. It is critical as patients' adherence to the pharmacological therapy significantly decreases the risk of long-term adverse events including mortality. It appears that combinations not only of hypotensive drugs but also with statins (as well as antidiabetics) will be widely used.
高血压是心脏和肾脏疾病的主要可改变风险因素之一，在普通人群中的患病率约为30%-45%，且随着年龄增长急剧上升。服用降压药物是为了降低主要临床心血管事件的风险。高血压指南建议，对于心血管风险高、有亚临床器官损害的患者，以及单一疗法失败时，采用联合治疗。涵盖领域：由于原发性高血压的病因是多因素的，使用不同类别的抗高血压药物进行联合治疗比单一药物有更大的效果（协同效应），可能具有更好的耐受性（两种成分可相互减少对方的副作用），并能提高患者的依从性。多项研究评估了药物联合治疗的降压效果；也有关于三联药物联合治疗的研究。专家评论：目前，双联和三联联合治疗可供高血压患者使用，临床效果良好，依从性高，副作用少。至关重要的是，患者坚持药物治疗能显著降低包括死亡率在内的长期不良事件的风险。似乎不仅降压药物之间的联合，而且与他汀类药物（以及抗糖尿病药物）的联合都将得到广泛应用。
